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Erector Spinae Plane Block with Ultrasound- and CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report

Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Nazia Nazir , Bhumika Gautam , Shivi Mishra , Samiksha Khanuja , Savita Gupta

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 20-07-2025; Reviewed: 15-08-2025; Accepted: 17-10-2024; Published: 10-12-2025


Authors: Nazia Nazir [1], Bhumika Gautam [1], Shivi Mishra [1], Samiksha Khanuja [1], Savita Gupta [1]

[1] Department of Anesthesiology and Critical Care Government Institute of Medical Sciences, Greater Noida, UP, India.

Address of Correspondence

Dr. Nazia Nazir,
Department of Anesthesiology and Critical CareGovernment Institute of Medical Sciences, Greater Noida, UP, India.
E-mail: nazunazir@gmail.com


Abstract

Background: Excision of giant pulmonary hydatid cysts carries high risks of cyst rupture, anaphylaxis, and respiratory compromise, necessitating precise lung isolation and robust regional analgesia.
Case Description: A 35-year-old female presented for posterolateral thoracotomy to excise a giant pulmonary hydatid cyst. The primary anesthetic goals were to ensure atraumatic lung isolation and minimize postoperative pulmonary complications.
Intervention: A multimodal approach was utilized: airway ultrasound and CT imaging were combined to precisely select a left-sided double-lumen tube (DLT). For analgesia, an ultrasound-guided erector spinae plane (ESP) block was administered preoperatively to facilitate an opioid-sparing technique.
Outcome: The strategy resulted in effective lung isolation, excellent intraoperative stability, and superior postoperative pain control. The patient was extubated early, demonstrated improved respiratory mechanics, and achieved an uneventful recovery with minimal opioid requirements.
Conclusion: Combining image-guided airway assessment with the ESP block provides a safe, effective, and comprehensive anesthetic strategy for high-risk thoracic procedures.
Keywords: Airway ultrasound, Double-lumen tube sizing, Erector spinae plane block, Thoracotomy analgesia, Pulmonary hydatid cyst, One-lung ventilation


References


1. Al-Hurani M, Al-Hadrab Y, Ayoub KR, Al-Salhi A, Al-Sarsour HS, Kocher GJ. Thoracoscopic Approach for Treating a Primary Hydatid Cyst in the Thymus in a Teenager: A Case Report. Am J Case Rep. 2025; 22;26: e948600.
2. Sachar S, Goyal S, Goyal S, Sangwan S. Uncommon locations and presentations of hydatid cyst. Ann Med Health Sci Res. 2014;4(3):447-52.
3. Pokhriyal, Abhimanyu Singh; Tomar, Sonu; Saran, Vinayak. Anesthetic management of the patient with large pulmonary hydatid cyst: A case report. Bali Journal of Anesthesiology 2024;8(1): 53-6
4. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane blocks in thoracic surgery. Anaesthesia. 2017;72(4):452–460.
5. Mathew RM, Gautam S, Raman R, Rai A, Srivastava VK, Singh MK. Evaluating the precision of ultrasound versus computed tomography-guided measurement of cricoid cartilage diameter for double-lumen tube selection in thoracic surgery: A randomised comparative study. Indian J Anaesth. 2024; 68(10):896-901.
6. Brodsky JB, Lemmens HJ. Left double-lumen tube size selection: A practical method.
Anesth Analg. 2005;100(3):853–856.
7. Pooja Chandran, Ankit Agarwal, Debendra K Tripathy, Nitish Thakur, Vikram Chandra. Anaesthetic Considerations in Simultaneous Management of Pulmonary and Hepatic Ruptured Hydatid Cyst: A Case Report. Archives of Anesthesiology and Critical Care 2023; 9(3): 265-267.
8. Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy. Ann Transl Med. 2019;7(8):174.


How to Cite this Article: Nazir N, Gautam B, Mishra S, Khanuja S, Gupta S. Erector Spinae Plane Block with Ultrasoundand CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00


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Continuous Erector Spinae Plane Block for Unilateral Multiple Rib Fracture- A Case Report

Vol 5 | Issue 2 | July-December 2024 | Page 23-26 | Navveen PM, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.102

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 22-11-2024; Reviewed: 28-11-2024; Accepted: 08-12-2024; Published: 10-12-2024


Authors: Navveen PM [1], Sandeep Diwan [2]

[1] AORA Fellow, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence

Dr. Navveen PM
Department of Anaesthesia, Sancheti Institute of orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email id: dr.navveen@gmail.com


Abstract

Patients with chest trauma have high morbidity due to rib fractures, lung contusion, hemo/pneumothorax leading to prolonged hospital stay. Adequate pain relief is the key for early recovery following rib fracture. Pain due rib fracture can cause lung atelectasis, flail chest, hypoventilation leading to hypoxia, respiratory failure and further pulmonary complications. Erector spinae plane (ESP) block is an inter-fascial plane block which has been proposed as a regional anaesthesia technique in acute pain management for multiple rib fractures (MRF’s).
Keywords: Multiple rib fracture, Chest trauma, Erector spinae plane block.


References


1. Kuo K, Kim AM. Rib Fracture. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541020/
2. Thoracic Paravertebral Analgesia Through a New Multiple-Hole Catheter- 2016/04/01. doi: 10.1053/j.jvca.2015.09.016. DO – 10.1053/j.jvca.2015.09.016. Journal of Cardiothoracic and Vascular Anesthesia
3. Kumar G, Kumar Bhoi S, Sinha TP, Paul S. Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series. Australas J Ultrasound Med. 2020 Aug 30;24(1):58-62. doi: 10.1002/ajum.12225. PMID: 34760612; PMCID: PMC8412024.
4. Diwan S, Garud R, Nair A. Thoracic paravertebral and erector spinae plane block: A cadaveric study demonstrating different site of injections and similar destinations. Saudi J Anaesth. 2019 Oct-Dec;13(4):399-401. doi: 10.4103/sja.SJA_339_19. PMID: 31572102; PMCID: PMC6753759.
5. L May, C Hillermann, S Patil, Rib fracture management, BJA Education, Volume 16, Issue 1, 2016,
6. Diwan, S., Nair, A., Adhye, B. et al. Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series. Ain-Shams J Anesthesiol 15, 81 (2023). https://doi.org/10.1186/s42077-023-00380-0
7. Diwan, Sandeep; Nair, Abhijit1. Unilateral erector spinae plane block for managing acute pain arising from multiple unilateral injuries: A case report. Indian Journal of Anaesthesia 64(1):p 79-80, January 2020. | DOI: 10.4103/ija.IJA_609_19
8. Periosteal Infusion of Local Anesthetics as an Alternative to Bilateral Subpectoral Interfascial Plane Catheters in Patients with Sternal Fractures, Regional Anesthesia & Pain Medicine. Paul, Barry. 2017/05/01.
9. Rashmi Syal, Sadik Mohammed, Rakesh Kumar, Nidhi Jain, Pradeep Bhatia, Continuous erector spinae plane block for analgesia and better pulmonary functions in patients with multiple rib fractures: a prospective descriptive study, Brazilian Journal of Anesthesiology (English Edition), Volume 74, Issue 1, 2024.


How to Cite this Article: PM Navveen, Diwan S | Continuous Erector Spinae Plane Block for Unilateral Multiple Rib Fracture- A Case Report | International Journal of Regional Anaesthesia | July-December 2024; 5(2):23-26 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.102


(Abstract Text HTML)    (Download PDF)