Effective Analgesia with Erector Spinae Plane Block in a 3-Year-Old Patient Undergoing Thoracotomy: A Case Report

Thoracotomy is associated with significant postoperative pain in pediatric patients. Inadequately managedpostoperative pain can lead to complications such as atelectasis and pneumonia due to impaired deep breathingand coughing, and insufficient analgesia within the first 24 hours may increase the risk of developing chronicpain. We present a pediatric patient who underwent thoracotomy and whose postoperative pain was managedwith an erector spinae plane block (ESPB). After obtaining informed consent from the patient's parents, a 3-year-old girl weighing 14 kg was taken to the operating room, where standard monitoring was applied.Anesthesia was induced with 2 mg/kg propofol, 1 μg/kg remifentanil, and 0.5 mg/kg rocuronium. Two minutesafter induction, the patient was intubated with a 4 mm internal diameter endotracheal tube. At the end of the120-minute surgical procedure, ultrasound guidance was used to identify the erector spinae muscle andtransverse processes at the T5 thoracic vertebral level. Using the in-plane technique in a craniocaudal direction,10 mL of 0.25% bupivacaine was injected into the fascial plane between the erector spinae muscle and thetransverse process. At the second postoperative hour, the patient was awake and cooperative; the FLACC (Face,Legs, Activity, Cry, Consolability) pain score was recorded as 1. Postoperative pain management followingthoracotomy is most commonly achieved using thoracic epidural or paravertebral catheters; however, bothtechniques carry significant risks and are technically challenging to perform in pediatric patients. This casesuggests that the erector spinae plane block (ESPB) may be an effective analgesic technique in pediatric thoracicsurgeries