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Bi-level erector spinae plane block for the control of severe back pain related to vertebral metastasis
  1. Başak Altıparmak1,
  2. Melike Korkmaz Toker2,
  3. Ali İhsan Uysal2 and
  4. Semra Gümüş Demirbilek1
  1. 1 Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Muğla, Turkey
  2. 2 Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
  1. Correspondence to Dr Başak Altıparmak, basak_ugurlu{at}


Pain is the most common reason for emergency department visits. Traditionally, pain management has been provided by narcotics, non-steroidal anti-inflammatory drugs and non-narcotics. Erector spinae plane block is a new interfascial plane block that has been successfully used for acute pain control in different surgeries. Two female patients with severe back pain related to breast cancer metastasis applied to emergency department. The pain scores of the patients were between 8 and 10. We performed bilateral erector spinae plane block at the levels of T3 and T6. The pain scores decreased under 2 within 30 min and none of the patients required additional analgesic agent for 24 hours. Previously erector spinae plane block was used for rib and spine fractures in emergency department. Different from previous cases, we performed bi-level blocks to cover a larger area and the block abruptly and effectively reduced pain scores of the patients with breast cancer.

  • anaesthesia
  • pain
  • emergency medicine
  • breast cancer
  • erector spinae
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  • Contributors BA, MKT, AIU and SGD contributed to conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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