Erector Spinae Plane Block in an Asthmatic, Post-Thymectomy, Myasthenia Gravis patient with repeated Myasthenic Crisis episodes for Percutaneous Nephrostomy and Cystoscopy

Myasthenia gravis is an autoimmune disorder attacking the neuromuscular junctions at the post-synaptic membrane causing fatigable weakness of skeletal muscles. These cases pose an anaesthetic challenge since drugs used in general anaesthesia interact with the anticholinesterase medications used for control of myasthenia gravis symptoms and result in post-operative complications like respiratory muscle weakness and continuation of ventilator support. Here we have used Erector Spinae Plane Block and supplemented it with minimal sedation along with preservation of spontaneous ventilation and thus avoided the complications associated with general anaesthesia in much patients. Keywords: Myasthenia gravis, Erector spinae plane block, Percutaneous nephrostomy, Cystoscope