A Case Report of Erector Spinae Plane Block Application During Abdominal Surgery in an Infant With Coagulation Disorder

BACKGROUND: This article presents a clinical case of combined anesthesia during abdominal surgery in which the analgesic component was provided by a bilateral erector spinae plane (ESP) block using 0.2% ropivacaine in a 2-month-old infant with a coagulation disorder. Selecting an optimal method of analgesia in pediatric patients requiring surgical intervention remains one of the most challenging issues in medicine. The use of regional analgesia as part of multimodal anesthesia is a safe and effective approach to perioperative pain management in neonates and infants. Epidural anesthesia is widely used and classified as a neuraxial block; however, despite its advantages, it has some contraindications and may be associated with rare but significant complications. Therefore, peripheral nerve blocks are increasingly used as an alternative.

CASE DESCRIPTION: This article demonstrates the feasibility and effectiveness of the ESP block as an alternative to epidural anesthesia in an infant admitted from a regional hospital at the age of 2 months and 3 days, presenting with hepatic failure and impaired hemostasis confirmed by laboratory blood tests. Immediately after birth, the patient required respiratory support for 29 days. The infant was admitted for further evaluation, diagnostic clarification, and treatment. After a series of additional examinations, a decision was made to perform surgery, including liver biopsy and cholecystocholangiography. Coagulation abnormalities in the blood test contraindicated epidural anesthesia. Consequently, to reduce the risks of ventilatory support and facilitate early enteral nutrition in the postoperative period, an ESP block was chosen as the method of regional anesthesia. The ESP block is a peripheral nerve block performed under ultrasound guidance, for which hemostatic disorders are not an absolute contraindication. Thus, effective multimodal postoperative analgesia was achieved without opioids; mechanical ventilation was not required, and early enteral feeding was successfully initiated.

CONCLUSION: This clinical case demonstrates the feasibility of using the ESP block as an alternative to epidural anesthesia as part of combined anesthesia in infants undergoing abdominal surgery. The use of peripheral nerve blocks is not limited by hypocoagulation. Given its technical simplicity and the use of ultrasound guidance, the risk of bleeding associated with the ESP block is minimal. This method may serve as a reliable component of multimodal anesthesia in children, including those in the neonatal period.