Case Report: Treatment of Refractory Post-Surgical Neuralgia with Erector Spinae Plane Block.

Background Peripheral nerve blocks (PNBs) are used for a wide spectrum of headache and facial pain disorders. The objective of this Case report is to highlight the erector spinae plane block, that has recently been reported to successfully treat headache. Case Presentation A 70 year-old male with history of mild to moderate headaches, previously ruptured aneurysm, and right pterional craniotomy and clipping of an anterior communicating artery aneurysm presents with exacerbation of chronic post surgical scalp pain and severe headache with nausea. Physical exam was not consistent with cellulitis of the scalp, CBC and chemistry panel were unremarkable, and imaging revealed an intact aneurysm clip. Given the severe unilateral throbbing pain with associated nausea, he was treated with a variety of migraine abortives and other pain medications without significant relief. Erector spinae plane (ESP) block was performed. He tolerated the procedure well without complications. His pain decreased to 2/10 from a baseline of 9-10/10 30 minutes after the procedure, and he was pain free the next day. Follow up revealed a return of his pain 1-2 two weeks after the procedure, which prompted follow up with an outpatient pain management specialist. Conclusion PNBs, ESP block in our case, can be a useful modality in managing chronic neuralgiform for treatment-refractory patients. It can provide improvement in quality of life and spare the patient from medication side effects. In inpatient setting, it can decrease length of stay that would otherwise be extended due to trial of multiple medications until pain is controlled.