A 42-year-old male (45 kg; 155 cm) with right Pancoast tumor severe pain (7/10 on NRS) from 5 months in dermatome distribution from C5 to T3, incompletely relieved on medical treatment. Right ESP block was given at T2 level in the sitting position. Following administration of 20 ml of 0.375% ropivacaine and 40 mg triamcinolone, pain was relieved in few minutes (1/10 on NRS) with sensory blockade from C3 to T5 on the right side. NRS score was noted for 24 h []. The patient was discharged with oral medications tapered. The patient was still pain-free without consumption of any other oral analgesics at the follow-up after 2 months.
Case 4: A 65 years old male (weight 76 kg, ASA status III) was scheduled for left THA. He was diagnosed with AS for 10 years, and developed necrosis of both femoral heads, and could not walk because of pain in the left hip joint. He had a history of hypertension for 10 years, and diabetes mellitus for 7 years, and smoking history for 50 years with nearly 50 cigarettes per day. A chest X-ray revealed enhanced texture of bilateral lungs and right pleural effusion. X-ray of his pelvic revealed bilateral femoral head necrosis, narrowed joint space, osteoproliferation and bone defect under articular surface of bilateral sacra-iliac joints and hip joints, and bamboo-like changes of lower lumbar spine.