An exceptional indication for bilateral thoracic paravertebral block performance in a pediatric patient.

We report a 10-year-old male patient (30 kg, 140 cm, ASA I) who underwent left latissimus dorsi muscle transfer (free flap) surgery under general anesthesia (GA) because of biceps brachii muscle motor weakness and atrophy occurring after oral (OPV) and inactive polio (IPV) vaccination (Figure 1). A decision was made to perform thoracic PVBs (TPVBs) bilaterally after surgery for postoperative pain management. With the patient in the right lateral decubitus position, a 10 MHz high-frequency linear transducer (GE LOGIQ book XP, GE Healthcare, Milwaukee, WI) was placed approximately 2-2.5 cm lateral to the tips of the spinous processes. Sonography demonstrated the consecutive transverse processes and pleura in between. The two level TPVBs was performed using the out-of-plane technique, aiming to block the dermatomes between T2 and T8 on the left side. After negative aspiration, a total of 20 ml of 0.125% bupivacaine was divided equally and deposited in paravertebral spaces of T3-T4 and T6-T7 while observing the pleura being moved downwards (Figure 2). Then, with the patient in the left lateral decubitus position, the same technique was used to perform a level T1 TPVBs to provide analgesia for levels C6-T2. Ten ml of 0.25% bupivacaine was injected and a 20-gauge catheter was placed to provide vasodilation of the free flap vascular anastomosis in addition to effective pain control. The catheter was then connected to an