Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block.

Multimodal anesthesia, which combines general and epidural anesthesia, is used in surgical cases in which a large or painful incision is anticipated. However, both epidural blocks and opioid-based analgesia have limitations in application. Here, we present a case of supra-infraumbilical laparotomy in a patient whose history of neurostimulator use and marked scoliosis discouraged the placement of an epidural catheter and whose prior adverse response to opioids prohibited their use. The intraoperative and postoperative management of this patient consisted of a combination of analgesia without opioids and erector spinae plane block. Adequate analgesia was achieved, and intraoperative or postoperative opioids were not required. This case illustrates the importance of mastering alternative and multimodal analgesia techniques that can be used in place of classical analgesia techniques when classical analgesia techniques are not appropriate.

Erector spinae plane block in abdominal surgery: Case series.

The aim of this study is to report 11 cases of erector spinae plane (ESP) block used for unilateral or bilateral abdominal surgery, adding to the overall limited experience with abdominal ESP block. The procedures were carried out at a teaching hospital in 11 patients (eight males, three females, ages 36-80 years) requiring abdominal surgery, including laparoscopic surgery. Each patient required surgery under different physical circumstances and likely different conceptions of what constituted pain. Two of the eleven patients were administered the ESP block and did not require general anaesthesia. Most of the patients with the ESP block maintained a numerical rating scale (NRS) for pain of 0-2/10 postoperatively. An occasional patient required paracetamol analgesia. There were no cases of opiate rescue. Obesity in a 46-year-old woman was believed to cause unclear ultrasonographic visualisation, interfering with entry of the ESP catheter. She, however, had no post-operative pain. She was given the usual intravenous metamizole 2 g for 10 h and required only analgesics at 16 h. ESP block, which produces analgesia by blocking trunk nerves, is an appropriate approach to patients requiring abdominal surgery, whether laparoscopic or open.