LAUSR

pinge on the surgical site [1,2] and interfere with postoperative neurological evaluation [1,2]. With this letter, we aim to propose the use of the continuous bilateral parascapular sub-iliocostalis plane (PSIP) block, which has been recently evaluated for posterior rib fractures [3], for thoracic spinal surgery given its safer profile [4]. The patient authorized the publication of this letter with anonymized details. The study was conducted in accordance with the 2013 Helsinki Declaration. A 25-year-old male with no past medical history presented with thoracic vertebral fractures (spinous processes and laminae of T5 and T6) caused by a motorcycle crash. He was 179 cm tall and weighed 73 kg. He underwent percutaneous transpedicular fixation of the thoracic spine (from T4 to T7) (Fig. 1A) in the prone position under general anesthesia. The intraoperative period was uneventful. Since postoperative pain was anticipated, multimodal intravenous (IV) analgesia (paracetamol 1,000 mg, metamizole 1,000 mg, parecoxib 40 mg, tramadol 150 mg, and morphine 6 mg) was administered 30–45 min before emergence from anesthesia. Nevertheless, in the post-anesthesia care unit, his pain was 9/10 on the numeric pain rating scale [NPRS] despite the administration of rescue analgesia (total of 10 mg of IV morphine boluses). In this context, contralateral decubitus PSIP blocks were performed. A high-frequency linear ultrasound probe (Acuson P300®; Siemens®, Germany) was placed in a parasagittal plane orientation 2 cm from the medial scapular border at the level of the edge of the scapular spine (fourth rib level) under sterile conditions. From the superficial to deep muscular layers, the trapezius, rhomboid major, iliocostalis, and intercostal muscles were visualized (Figs. 1B and 1C). A sonovisible 100 mm 18 G needle (SonoLong Echo NanoLine®; Pajunk®, Germany) was inserted in a caudal-to-cranial orientation using the in-plane technique and advanced in the iliocostal-intercostal plane to the vicinity of the fourth rib. The needle location was confirmed using a 2 ml saline solution, after which 25 ml of 0.375% ropivacaine (Kabi-Fresenius®, Portugal) was administered. A catheter was then inserted 6 cm beyond the needle tip and tunneled under the skin. Fifteen minutes after the local anesthetic (LA) was administered, the patient reported 2/10 pain on the NPRS. The techniques were performed laterally to the surgical dressing/drapes. The patient did not report any sensory or motor changes after receiving the blocks. The analgesic protocol consisted of 0.2% ropivacaine (20 ml boluses) administered through each PSIP catheter every 6 h, and IV paracetamol (1 g every 8 h), IV metamizole (1 g every 12 h), IV parecoxib (40 mg every 12 h), and IV tramadol (100 mg every 8 h), with IV morphine (3 mg every 6 h) prescribed for rescue analgesia. The patient was discharged to the intermediate care unit in the same day, where significant pain control was maintained (NPRS 1–2/10 at rest and 1–3/10 during movement) and no rescue analgesia was necessary. The patient did not report any therReceived: November 6, 2021 Revised: November 15, 2021 (1st); November 17, 2021 (2nd); November 18, 2021 (3rd) Accepted: November 19, 2021