Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims The ESP block is an interfascial plane block first described in 2016 in the management of thoracic neuropathic pain. Since then, it has found use as an analgesic option in various settings including cardiac and spine surgeries. In this case series, we describe the application of an ESP block in two patients undergoing endoscopic retroperitoneal adrenalectomy.

Methods We conducted these ESP blocks as part of multimodal analgesia in conjunction with general anaesthesia. 25mls of 0.5% Ropivacaine was administered for both cases in the erector spinae plane in conjunction with general anaesthesia. This was conducted at the level of the T9 Transverse Process in Patient 1 and T12 Transverse Process in Patient 2.

Results The use of an ESP block provided satisfactory analgesia with a reported NPRS of 5 out of 10 with 90% satisfaction for our first patient on POD 1. Additionally, our second patient reported no pain at rest and mild pain on movement with 90% satisfaction for pain relief on POD 1. Both patients required 5mg of oxycodone cumulatively in the intra and post-operative period. Both patients required no additional opioids on the general ward and were discharged on POD1.

Conclusions The use of ESP blockade can be considered as an analgesic option in conjunction with multimodal analgesia for endoscopic retroperitoneal adrenalectomy surgery. This potentially allows for decreased opioid usage and reduction of its associated side effects. The use of such a technique to decrease incidence of chronic post-surgical pain (CPSP) in these patients remains to be studied.