Sacral multifidus plane block for high-risk patients undergoing perianal surgery: two case reports

초록

Erector spinae plane block has emerged as an effective analgesic technique. Sacral multifidus plane block (SMPB), a more appropriate term than sacral erector spinae plane block, is used to provide analgesia or anesthesia during various surgeries. However, SMPB has not been reported in high-risk patients. We describe the use of SMPB as an anesthetic technique for high-risk patients requiring anticoagulation or antiplatelet therapy during perianal surgery. SMPB was performed during perianal surgery in two patients: an advanced-age woman with severe aortic stenosis and heart failure and a man with heart failure and a history of sudden cardiac arrest. With the patient in the jackknife position, 10 mL of 0.25% ropivacaine was administered at the S2 and S4 levels after confirming both sacral intermediate crests. After confirming the absence of perineal pain, the surgery was successfully completed under sedation. Neither patient required additional analgesics on the day of surgery. Based on the absence of pain during the perioperative period, SMPB appears to provide effective anesthesia during perianal surgery in high-risk patients. However, further investigations are needed to confirm the mechanism of SMPB.

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