Determination of Tramadol as an Adjuvant to Ropivacaine in Utrasound Guided Erector Spinae Plane Block for Postoperative Analgesia after Sternotomy

Abstract

The erector spinae plane (ESP) block, which is guided by ultrasound, is beneficial for controlling postoperative pain in thoracoabdominal procedures. The duration of the block can be extended with the increasing usage of adjuvants in local anesthetics. In this case we used tramadol as an adjuvant to ropivacaine for single shot bilateral ultrasound guided ESP block, to provide effective analgesia in a patient undergoing surgery for resection of anterior mediastinal teratoma through midline sternotomy. The resection of a mediastinal teratoma in a 21-year-old female patient was planned through a median sternotomy. She was put under general anaesthesia using standard medications. The patient was given a bilateral ultrasound guided ESP block with 10 ml of injection ropivacaine 0.2 percent and 50 mg tramadol at T5 level on each side at the end of surgery. For the first 24 hours, visual analogue scores (VAS) were in the range of 2-3, and for the next 24 hours, they were in the range of 1. For the first 48 hours after surgery, the patient did not require any analgesics and was pain-free. The use of an ultrasound-guided ESP block can effectively control severe sternotomy postoperative pain. Tramadol can also be used as an adjuvant to extend the duration of the block for up to 48 hours.