Our patient, a 52-year-old male (165 cm, 90 kg), was a known case of chronic lymphocytic leukemia (CLL, Rai Stage II). He had received two cycles of bendamustine and rituximab-based chemotherapy in two consecutive months. He developed herpes zoster infection in the following month and was started on oral acyclovir after consultation with a dermatologist. One week later, he visited our pain clinic and complained of severe pain on the right side of his lower back []. The pain was burning in nature and was associated with allodynia and restricted mobility. A diagnosis of PNH was made, and he was started on gabapentin in view of neuropathic nature of pain. The dermatomal distribution of the pain was from T11 to S1. The pain was affecting the quality of life of the patient and the pharmacological therapy was inadequate.\nWe decided to perform a right-sided ESPB in prone position for acute pain relief of the patient. A high-frequency linear ultrasound probe was placed in longitudinal orientation, about 3 cm lateral to the spinous process of the third lumbar vertebra. The interfacial plane below the erector spinae muscle was identified, and 0.25% bupivacaine and triamcinolone 40 mg (total volume 30 ml) were injected []. Patient's NRS score was decreased from 8/10 to 3/10 30 min after the block procedure. Later on, the ESPB was performed two times for 2 weeks and provided effective analgesia for the PHN. The patient reported a decline in pain score and analgesics consumption in follow-up clinics.
A 68-year-old female patient (161 cm, 50 kg) with a 21-mm large mass in the upper pole of the right kidney was scheduled for RAPN peritoneal approach. The anesthetic method and block were similar to those in case 1.\nThe operative and anesthetic times were 271 and 326 min, respectively. The patient intraoperatively received intravenous fentanyl 200 μg and acetaminophen 750 mg. The surgical procedure was different from that of case 1 with respect to the placement of a single and surgery time extension. Postoperative pain was managed in the ward using continuous intravenous infusion of 25 μg/h fentanyl combined with 25 μg fentanyl for IV-PCA with 10-min lockout.\nA pinprick test performed at 2 h after surgery revealed that the anesthetized dermatomal range was Th7–Th12. The NRS scores were 3-0-0-0/10 at rest and 5-1-1-3/10 on movement at 2, 12, 24, and 48 h after surgery, respectively. Acetaminophen was administered once at POD 0. IV-PCA was stopped at 67 post-surgery hours. The total fentanyl amount post-operatively used was 2425 μg. She was discharged without adverse events at 7 days after surgery.