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Objectives: Tarlov cysts are sacral perineural cysts which occur in up to 4.6% of the population. Neuraxial anesthesia is relatively contraindicated in these patients. Similarly, many of these patients have chronic pain from the cysts, often requiring chronic opioid use. Pain during labor may be difficult to control in these patients due to concerns regarding neuraxial analgesia and submaximal benefit from systemic remifentanil infusions. The Erector Spinae Plane (ESP) Block has recently been described as a regional technique for thoracic and abdominal procedures which can decrease both somatic and visceral pain. Case report: We report the use of an ESP block in the peripartum period in a patient with history of Tarlov cysts and who was chronically on the partial opioid agonist buprenoprhine. The patient had inadequate pain control on a remifentanil PCA and requested additional pain relief, though neuraxial anesthesia was relatively contraindicated in this patient due to a history of Tarlovcysts. She had significant postpartum pain following manual extraction of twin placentas as well as placement of an intrauterine balloon control of postpartum hemorrhage. Following placement of an ESP block at the T10 spinal level she experienced significant pain relief. Conclusions: The use of an ESP in this population is promising due to its ability to cover the affected spinal levels and be given as a continuous infusion. Patients who cannot receive a neuraxial technique for anatomic reasons can reasonably be given an ESP block with comparable efficacy.

Erector Spinae Plane Block for Peripartum Analgesia in a Patient with Tarlov Cysts