Successful Use of Continuous Erector Spinae Plane Blocks in a Patient With Variant Angina After Large Ventral Hernia Repair

Authors

Alexandra L Belfar
Yi Deng
Raymond C Yu
Annas Sabbagh

Publication Date

11-1-2022

Journal

The Texas Heart Institute Journal

DOI

10.14503/THIJ-21-7624

PMID

36534113

PMCID

PMC9809071

PubMedCentral® Posted Date

11-1-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Coronary Vasospasm, Angina Pectoris, Variant, Hernia, Ventral, Nerve Block, Angina pectoris, variant; Prinzmetal angina; coronary artery spasm; analgesia

Abstract

Coronary artery spasm constitutes the primary underlying pathology of variant angina. Because provocation of coronary artery spasm may occur with both excess sympathetic and excess parasympathetic stimulation, patients with this disorder have extremely limited options for perioperative pain control. This is especially true for procedures involving extensive abdominal incision/manipulation. Whereas neuraxial analgesia might otherwise be appropriate in these cases, several studies have demonstrated that coronary artery spasm can occur as a result of epidural placement, and therefore, that this may not be an optimal choice for patients with variant angina. This report discusses the case of a patient with a preexisting diagnosis of variant angina who underwent an exploratory laparotomy with large ventral hernia repair and for whom continuous erector spinae plane blocks were successfully used as analgesic adjuncts without triggering coronary artery spasm.