Colontonio, Matthew M.

Pain management after thoracotomy is particularly complex in lung transplant recipients on extracorporeal membrane oxygenation (ECMO), where anticoagulation significantly limits available treatment options. Coagulopathy constitutes a contraindication to neuraxial and deep peripheral nerve blocks due to hemorrhagic complications. Uncontrolled thoracotomy pain, hypoxia due to increasing opioid use, and hemodynamic instability can delay successful weaning from ECMO. We present the case of a patient on bivalirudin after undergoing a thoracotomy for a right lung transplantation. This case highlights the successful use of a serratus anterior plane block (SAPB) as an alternative approach to neuraxial anesthesia in an anticoagulated patient, optimizing analgesia and facilitating recovery postthoracotomy.

Suzetrigine is a unique, nonopioid oral analgesic that selectively inhibits voltage-gated sodium channels in peripheral nerves. The Food and Drug Administration (FDA) recently approved it, and we present the first successful use of suzetrigine in a 16-year-old boy with hereditary neuropathy who underwent foot reconstruction surgery. His postoperative pain management plan included a sciatic nerve catheter, a 14-day course of suzetrigine, opioids, and home medications. His pain was well controlled with no side effects. Within 24 hours of stopping suzetrigine, the patient’s pain rapidly intensified, suggesting suzetrigine’s effectiveness in postoperative pain management in an adolescent patient with neuropathy.