Background and Aims Erector Spinae Plane Block (ESPB) is a novel analgesic method performed for numerous surgeries. This case report describes the performance of continuous bilateral ESPB for perioperative analgesia management of a high-risk-patient who presented at the emergency department with a massive abdominal wall hernia.

Methods A 69-year-old, female patient presented at the emergency department with a massive abdominal wall hernia with inflammation and bowel necrosis. The patient was obese and suffered from hypertension, type II diabetes, heart failure, coronary disease and COPD. Our goal was to provide opioid-free anesthesia and we performed a bilateral ESPB along with placement of continuous infusion catheters at T10 level, under ultrasound guidance. An epidural block could not be performed as the coagulation laboratory tests were prohibitive and the body type of the patient was discouraging. After induction of general anesthesia, analgesia was guided by NOL monitor readings. Surgery included right hemicolectomy and hernia repair with mesh. Intraoperative analgesia included Paracetamol 1000 mg and a bolus dose of Ropivacaine 0.2% (20 ml) to each ESPB catheter. No complications were reported perioperatively. Post-operative analgesia was achieved with Paracetamol along with bolus doses of Ropivacaine 0.2% (20 ml to each catheter) every 12 hours, for the first three postoperative days.

Results The bilateral ESPB contributed to the patient’s perioperative analgesia, mobilization and satisfaction.

Conclusions ESPB is a novel peripheral nerve block, which can be performed safely from an experienced anesthesiologist under ultrasound guidance and can serve as an alternative anesthetic plan providing excellent perioperative analgesia to high-risk patients undergoing major abdominal surgeries.