A 64-year-old male (46 kg, 152 cm) presented with postthoracotomy pain syndrome 1 year after undergoing right bilobectomy. He had severe pain (9/10 on NRS) over the anterior and posterior right chest area and described it as burning, tingling, and current-like sensation around the thoracotomy scar at the T8-T9 level. Despite the high dosage of oral analgesics, he experienced significant pain. A right ESP block with 20 mL of 0.375% ropivacaine and 40 mg of triamcinolone was performed at the T8 level. Following the injection, pain was relieved in few minutes (0 on 10 on NRS) with sensory blockade from T5 to T12 on the right side. NRS score was noted for 24 h []. The patient was discharged with oral medications tapered. The patient remained pain-free for 1.5 months without consumption of any other oral analgesic. A second ESP block was performed with 20 mL of 0.25% ropivacaine and 40 mg triamcinolone which again produced significant analgesia lasting 2 weeks.
Case 2: A 61 years old male (weight 75 kg, ASA status III) suffered from AS for 20 years, and was scheduled for left total hip arthroplasty (THA). He had a history of coronary heart disease and received coronary stent implantation 7 years ago. A physical examination revealed rigidity of cervical and lumbar spine, severe press pain and immobilization of left hip joints. An X-ray of the neck, chest and lower back revealed bamboo-like changes of the spine. CT of the hip joints reported necrosis of the left femoral head, and ankylosis of left hip joint. He had taken aspirin for anticoagulation therapy for a long term, and was replaced by low molecular weight heparin.