A 68-year-old female patient (161 cm, 50 kg) with a 21-mm large mass in the upper pole of the right kidney was scheduled for RAPN peritoneal approach. The anesthetic method and block were similar to those in case 1.\nThe operative and anesthetic times were 271 and 326 min, respectively. The patient intraoperatively received intravenous fentanyl 200 μg and acetaminophen 750 mg. The surgical procedure was different from that of case 1 with respect to the placement of a single and surgery time extension. Postoperative pain was managed in the ward using continuous intravenous infusion of 25 μg/h fentanyl combined with 25 μg fentanyl for IV-PCA with 10-min lockout.\nA pinprick test performed at 2 h after surgery revealed that the anesthetized dermatomal range was Th7–Th12. The NRS scores were 3-0-0-0/10 at rest and 5-1-1-3/10 on movement at 2, 12, 24, and 48 h after surgery, respectively. Acetaminophen was administered once at POD 0. IV-PCA was stopped at 67 post-surgery hours. The total fentanyl amount post-operatively used was 2425 μg. She was discharged without adverse events at 7 days after surgery.
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.