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 4: A 65 years old male (weight 76 kg, ASA status III) was scheduled for left THA. He was diagnosed with AS for 10 years, and developed necrosis of both femoral heads, and could not walk because of pain in the left hip joint. He had a history of hypertension for 10 years, and diabetes mellitus for 7 years, and smoking history for 50 years with nearly 50 cigarettes per day. A chest X-ray revealed enhanced texture of bilateral lungs and right pleural effusion. X-ray of his pelvic revealed bilateral femoral head necrosis, narrowed joint space, osteoproliferation and bone defect under articular surface of bilateral sacra-iliac joints and hip joints, and bamboo-like changes of lower lumbar spine.