Nerve block technique
tumor, ESPB
STERILE, TUMOR, PERIOSTEUM, INFILTRATED
Patients in the ICNB group received a single-shot intrathoracic ICNB after tumor extraction, approximately 30 minutes before the end of the surgery. They received 20 ml of 0.5% levobupivacaine with injections at 6 intercostal spaces, adjacent to the surgical wound. The perineural intercostal space was located under direct vision. The same surgeon performed all the surgeries and executed the ICNBs.Patients in the ESPB group received a 20 ml bolus of 0.5% levobupivacaine through the ESPB catheter approximately 30 minutes before the end of the surgery, continued by an infusion of 5 ml/h 0.2% ropivacaine with intermittent boluses of 15 ml per 4 hours.Two anesthesiologists, experienced in regional anesthesia, were inserting catheters to the patients before the surgery in the pre-op area. The standard monitoring and i.v. canal were applied before the intervention. The ESPB catheter insertion was performed using Samsung© ultrasound with a GE 12L-RS high-frequency linear probe. Aseptic conditions were guaranteed by using sterile drapes, sterile probe dressings, gloves, masks, and surgical gowns. The catheter insertion underwent in a pronated position with the patient lightly sedated by 1–2 mcg/kg fentanyl. The insertion site was infiltrated with 2 ml of 2% lidocaine on the T4 level of the spine, approximately 3 cm ipsilateral from the midline on the transverse process. The needle was then inserted under ultrasound guidance, positioning the needle tip immediately above the periosteum. The position was confirmed by injecting approximately 10 ml of 0.9% sodium chloride solution, which caused a hydro-dissection between the Ultrasound image of the inserted ESPB catheter (marked by an arrow) and interfascial hydro-dissection.1 – underlying thoracic lamina, 2 – m. 