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 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.