P278 Erector spinae plane block for chronic cystitis pain: a novel approach

<h3></h3> <b>Application for ESRA Abstract Prizes:</b> <h3>Background and Aims</h3> Chronic cystitis is a cause of chronic pelvic pain, often difficult to manage and with significant impact on quality of life. We propose the Erector Spinae Plane Block (ESPB) as a novel analgesic option for this condition, not previously reported in the literature. <h3>Methods</h3> We present the case of a 76-years-old hypertensive woman with a history of transuretheral resection of a bladder tumor. She developed chronic cystitis following BCG therapy, unresponsive to pharmacological treatment over a four-year period, including codeine, tramadol, paracetamol and pregabalin. CT scans, cystoscopies and urine cultures were unremarkable. An ultrasound-guided bilateral ESPB was performed at the L5 level under aseptic conditions. Each side received 10 ml of 0,25% bupivacaine, 60 mg of triamcinolone, and 2 ml saline. Three weekly sessions were administered. <h3>Results</h3> The patient experienced significant pain relief. At three months follow-up, recurrence of symptoms led to a repeat of the same protocol. Since then for the past six months, her VAS score has remained at 3/10. We propose that the ESP block may provide visceral analgesia by blocking sympathetic pathways, though variable paravertebral spread observed in anatomical studies may explain heterogeneous outcomes. Its precise mechanism remains uncertain. <h3>Conclusions</h3> Chronic pelvic pain due to cystitis remains a therapeutic challenge. This case suggests that ESPB may offer effective pain relief in selected patients, which represents an advantage given its high technical feasibility. Controlled studies are needed to confirm these findings.