Article

Ultrasound guided erector spinae plane block for bilateral lumbar transverse process fracture: A new or a pushing indication?

ultrasound guided Erector spinae plane b”>Correspondence / American Journal of Emergency Medicine 37 (2019) 530559 557

Ultrasound guided erector spinae plane block for bilateral lumbar transverse process fracture: A new or a pushing indication?

Dear Editor,

We have read with great interest a case report written by Ahiskalioglu et al. [1] entitled “Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: A new indication”. They performed an erector spinae plane (ESP) block at the T10 level for a 60-year-old female patient who presented with a bilat- eral isolated L2 transverse process fracture. The ESP block was described by Ferero et al. [2]. The ESP block has been used as a postoperative anal- gesia technique for various indications such as thoracic surgery and mastectomy. Additionally, ESP block was used for rib fractures for pa- tients with trauma [1]. However, in the case report presented by Ahiskalioglu et al., they decided to perform an ESP block for pain man- agement in the seated position. Unfortunately, although they are con- sidered relatively minor injuries, fractures of the transverse processes (TP) of the lumbar vertebrae appear as a consequence of major forces. Patten et al. conducted a study of transverse process fractures in the lumbar vertebrae, and they found that there is a statistically significant association between transverse process fractures and abdominal vis- ceral injuries such as renal, splenic and hepatic injuries. In their study population, the mortality rate was 10% [3]. In another study, the authors determined that transverse process fractures might be a sign of more se- vere injuries [4].

We would like to enter the debate and address some of our concerns to the authors. 1) What was the cause of the bilateral lumbar transverse process fracture? Was it from a traffic accident or fall? According to the literature, these types of injuries are not common, and it is possible that a TP fracture might present with other injuries. 2) What was the authors rationale for placing the patient in the seated position after a TP frac- ture? Is it safe to place the patient in the seated position even though the patient could have important concomitant injuries such as liver, renal and spleen injuries? 3) The Healing time for a transverse process fracture has been reported to be between a few weeks and 3 months [5]. In addition, acute pain can develop into Chronic back pain. We would like to ask the authors whether they think that managing the pain for only 24 h is sufficient to prevent chronic pain? What were the patient’s Visual analogue scale scores after 24 h? Did the patient need rescue analgesics during the 24 h after ESP block? What type of oral an- algesic was administered? Non-steroidal anti-inflammatory drugs or opioids?

In conclusion, despite the successful pain management with ESP block in the present case report, interpretation of the results should be considered in light of the answers to the abovementioned questions.

Financial support

No financial support existing.

Ince Ilker, MD

Ataturk University School of Medicine, Department of Anesthesiology and

Reanimation, Turkey Research Fellow of Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA Corresponding author at: Ataturk University Faculty of Medicine, Yakutiye Research Hospital Department of Anesthesiology and Reanimation, 2500 Yakutiye, Erzurum, Turkey.

E-mail address: [email protected].

Khan Mohammad Zafeer, MD Research Fellow of Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA

E-mail address: [email protected].

Shimada Tetsuya, MD Research Fellow of Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA

Department of Pharmacology, National Defense College, Tokorozawa,

Saitama, Japan E-mail address: [email protected].

https://doi.org/10.1016/j.ajem.2018.07.048

References

  1. Ahiskalioglu Ali, Kocak Abdullah Osman, Doymus Omer, Sengun Emre, Celik Mine, Alici Haci Ahmet. Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: a new indication. Yajem 2018. https://doi.org/ 10.1016/j.ajem.2018.06.072.
  2. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic Neuropathic pain. Reg Anesth Pain Med 2016; 41:621-7.
  3. Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology 2000 Jun;215(3):831-4.
  4. Newell N, Pearce AP, Spurrier E, Gibb I, Webster CE, Clasper JC, et al. Analysis of iso- lated transverse process fractures sustained during blast-related events. J Trauma Acute Care Surg 2018 Jul;85(1S Suppl. 2):S129-33.
  5. Elenburg JL, Foley BS, Roberts K, Bayliss AJ. Utilization of mechanical diagnosis and

    therapy (MDT) for the treatment of lumbar pain in the presence of known lum- bar transverse process fractures: a case study. J Man Manip Ther 2016 May;24 (2):74-9.

    Acute presentations of Infective endocarditis

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