A 19-year-old female (50 kg; 160 cm) was admitted in the palliative care unit of our department with complaints of severe burning and stretching pain in the right flank region. Her pain scores were 10/10 on the Numeric Rating Scale (NRS), where 0 means no pain and 10 means worst possible pain. The patient was a postoperative case of desmoid tumor for which resection was done 2 years back []. Skin on the right side flank region develops pain, thickness, and tenderness from the past 6 months. The patient received medical treatment (morphine, nonsteroidal anti-inflammatory drugs [ibuprofen and paracetamol], and gabapentin), but the pain did not improve. Hence, we decided to perform lumbar ESP block.\nUnder all aseptic precautions, a linear ultrasound probe was placed longitudinally at the level of transverse process of L2. The skin was infiltrated with 2 ml of 1% lignocaine. The 10-cm Stimuplex needle (Stimuplex® A, B. Braun Melsungen AG, Germany) was inserted by the in-plane approach to touch the surface of transverse process of L2 []. A total of 20 ml of 0.375% ropivacaine and 40 mg triamcinolone was injected into the target plane between the erector spinae muscles and the transverse process. The patient had adequate pain relief (3/10 on NRS) 10 min after the block and had extensive sensory blockade from dermatome T10 to L5. NRS was noted for 24 h after the procedure []. The patient was discharged with oral medicines tapered. The patient was still pain-free without consumption of any oral analgesics at follow-up after 8 weeks.
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.