A 19-year-old female (50 kg; 160 cm) was admitted in the palliative care unit of our department with complaints of severe burning and stretching pain in the right flank region. Her pain scores were 10/10 on the Numeric Rating Scale (NRS), where 0 means no pain and 10 means worst possible pain. The patient was a postoperative case of desmoid tumor for which resection was done 2 years back []. Skin on the right side flank region develops pain, thickness, and tenderness from the past 6 months. The patient received medical treatment (morphine, nonsteroidal anti-inflammatory drugs [ibuprofen and paracetamol], and gabapentin), but the pain did not improve. Hence, we decided to perform lumbar ESP block.\nUnder all aseptic precautions, a linear ultrasound probe was placed longitudinally at the level of transverse process of L2. The skin was infiltrated with 2 ml of 1% lignocaine. The 10-cm Stimuplex needle (Stimuplex® A, B. Braun Melsungen AG, Germany) was inserted by the in-plane approach to touch the surface of transverse process of L2 []. A total of 20 ml of 0.375% ropivacaine and 40 mg triamcinolone was injected into the target plane between the erector spinae muscles and the transverse process. The patient had adequate pain relief (3/10 on NRS) 10 min after the block and had extensive sensory blockade from dermatome T10 to L5. NRS was noted for 24 h after the procedure []. The patient was discharged with oral medicines tapered. The patient was still pain-free without consumption of any oral analgesics at follow-up after 8 weeks.
A 46-year-old male (body weight 69 kg, ASA status II) was scheduled for right total hip arthroplasty (THA). He suffered from ankylosing spondylitis for 20 years. Physical examination indicated that the cervical and lumbar spine was rigid and the right hip joint was immobilized. The bamboo-like changes of spine were found in the spinal anterioposterior and lateral radiographs (Fig. ). X-ray and CT examination indicated degenerative osteoarthrosis of bilateral hip joints and sacroiliitis on the right side. The patient appeared potentially difficult to be intubated as the examination of airway revealed that the interincisor distance was 2 cm and a Mallampati class III. The preoperative visual analog scale (VAS) score of this patient was 4. This patient received ultrasound-guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks, and 25 mL of 0.4% ropivacaine was used. Pinprick test was used to confirm the success of these blocks. The time of surgery was 1 hour and 26 minutes. He also did not complain any painful during surgery and in PACU. With the PCA, the postoperative VAS scores were 0 to 1. This patient discharged on the second day after surgery. No postoperative complication was reported with him.