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.
An 84-year-old female (body weight 56 kg, ASA status III) was scheduled for right artificial femoral head replacement. Her pelvic X-ray revealed a right intertrochanteric fracture. She had hypertension for 35 years and chronic obstructive pulmonary disease (COPD) for 20 years. She took daily oral nifedipine for hypertension, but did not take any treatment for COPD. The result of pulmonary function test showed that the FEV1/FVC was 35% and the bronchodilator test was negative. Cardiac Doppler ultrasonography indicated moderate pulmonary artery hypertension. A chest X-ray revealed pulmonary infection of bilateral lower lobes. Low-molecular-weight heparin was used for prevent thrombus formation at 4000IU per day and stopped 24 hours before surgery. The preoperative visual analogue scale (VAS) score of this patient was 6. The ultrasound guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks were performed on this patient as described in the Methods section, and 25 mL of 0.4% ropivacaine was used for these blocks. The success of these blocks was confirmed by pinprick test. The time of surgery was 42 minutes. She did not complain any painful during surgery and in postanesthesia care unit (PACU). As postoperative analgesia was achieved by patient-controlled analgesia (PCA), the postoperative VAS scores were 0 to 1. This patient discharged on the fifth day after surgery. No postoperative complication was reported with her.