Continuous Erector Spinae Plane Block for Pain Management in a Pediatric Kidney Transplant Recipient: A Case Report and Review of the Current Literature

Pain management in patients undergoing kidney transplantation requires careful consideration due to their altered physiology, and potential risks associated with certain analgesic options. In recent years, personalized and multimodal approaches have proven to be pivotal in perioperative pain management, as well as in children. Implementing regional analgesia methods offers a valuable solution in many pediatric surgical settings and the erector spinae plane block (ESPB) could represent a possible analgesic strategy in pediatric patients undergoing renal transplantation. Here, we report the case of a 13-year-old child who underwent living-donor kidney transplantation (LDKx) and received continuous erector spinae plane block (ESPB) for perioperative pain management. This multimodal approach with continuous ESPB resulted in optimal pain control without the need for opioids, allowing for early mobilization and for an optimal postoperative course

Customized cutting template to assist sternotomy in pectus arcuatum

Purpose Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle is crucial for successful correction. We present the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. Description From patients\u2019 computer tomography scans, the optimal cutting angle is obtained through computer aided design (CAD). A template comprising of slots tilted at the right cutting angle and safety block to avoid damaging the posterior periosteum is printed through additive manufacturing. Evaluation The template allows to perform a precise wedge sternotomy, safely sparing the posterior periosteum in all patients, without complications. Post-operative chest x-rays and pictures demonstrate optimal sternal realignment and cosmetic outcome. Mean operative time was 110 min. All patients were successfully discharged with a mean length of stay of 4 days. Conclusions Transverse wedge sternotomy aided by CAD-devised cutting template may reduce the technical challenge of this procedure, increasing its safety, reducing operative times and hospital stay. Further research on long-term patient outcome is necessary