Background and Aims Nowadays, even major abdominal surgeries are performed laparoscopically. However, patients complain for severe postoperative pain and the role of the anesthesiologist for its effective management remains crucial. In this case series, we evaluated the efficacy of continuous bilateral Erector Spinae Plane Block (ESPB) for the management of perioperative pain of patients undergoing major laparoscopic abdominal surgery.

Methods We enrolled four patients undergoing laparoscopic pacncreaticoduodenectomy, laparoscopic hepatectomy and laparoscopic Nissen fundoplication surgery. Ultrasound-guided ESPB was performed in all patients 30 minutes before induction of general anesthesia at T9 level. Ropivacaine 0.375% (20 ml) was infused at each side 30 minutes before the induction of general anesthesia and Ropivacaine 0.2% (20 ml) was infused at each side 12, 24, 36 and 48 hours after surgery through continuous infusion catheters. Intraoperative monitoring of the patients included BIS and NOL monitors for the management of intraoperative depth of anesthesia and analgesia, respectively.

Results All patients remained stable and no complications were recorded. The mean intraoperative remifentanil administration was 0.02 mcg/kg/min. Postoperative analgesia included paracetamol 1000 mgx4 and ropivacaine infusion from ESPB catheters. No opioids were administrated to the patients postoperatively. NRS scores at several time points after surgery were <3. All patients were mobilized the day after surgery and their mean satisfaction score regarding their perioperative analgesia was 5.5 out of 6.

Conclusions ESPB performance is an innovative and simple method which can be a game-changer in improving the quality of perioperative analgesia, while it contributes in achieving enhanced recovery to patients undergoing major laparoscopic abdominal surgeries.