Ultra sound guided erector spinae plane block for perioperative analgesia in post coronary artery bypass grafting sternal dehiscence (Type 2b) patient posted for pectoralis major flap

Sternal dehiscence is a grave complication after cardiac surgery. Deep sternal dehiscence usually requires debridement and flap coverage as the mainstay of management. The perioperative period is considered very challenging and the anesthetic technique has a direct impact on the risk of perioperative complications. Perioperative pain management is usually carried out with the help of regional anesthetic techniques as they offer various benefits for this patient population, including the provision of high-quality analgesia, reduced requirements for opioids and nonsteroidal anti-inflammatory drugs, and reduced autonomic system activation. Conventionally, regional anesthesia techniques such as epidural and paravertebral blocks have been shown to provide effective analgesia and enhance postoperative recovery. However, these techniques were associated with minimal but unacceptable complications. Ultrasound-guided erector spinae plane (ESP) block is a recently described technique providing thoracic analgesia. This is the first case report to our knowledge, which describes the use of ESP block as perioperative analgesic technique for pectoralis flap in a high-risk cardiovascular patient.