A 73-year-old female (body weight 64 kg, ASA status III) who suffered from rheumatoid arthritis (RA) for 30 years was scheduled for right total knee arthroplasty (TKA). X-ray of her bilateral knee joint revealed that the joint cavity of bilateral knee joints was narrow and osteophyte formatted in the right side. The patient had hypertension for 6 years and was treated with oral nitrendipine. She also had a history of cerebral infarction 3 years ago. MRI of brain revealed multiple old softening foci in the right basal ganglia region. She had taken aspirin and ginkgo tablets for anticoagulation therapy and prevention of recurrent stroke. The preoperative visual analog scale (VAS) score of this patient was 4. The ultrasound-guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks were performed with 25 mL of 0.4% ropivacaine. Pinprick test was used to confirm the success of these blocks. This technique completely met the analgesic requirement of this patient during surgery. The time of surgery was 1 hour and 12 minutes. With the PCA, the postoperative VAS scores were 0 to 1. This patient discharged on the third day after surgery. No postoperative complication was reported with her.
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.