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Background and Aims Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in perioperative pain management for open abdominal surgery. In patients presenting with sepsis there is a concern with possible dissemination of the infection, hemodynamic instability and coagulopathy development in the context of sepsis. With this in mind, we should have different options for pain control.

Methods A 65-year-old female patient was proposed for an urgent exploratory laparotomy due to anastomotic leak after an enterectomy. She presented with fever and hypotension and was receiving antibiotic therapy. Due to the concern of her condition worsening, it was decided not to perform an epidural block. In alternative, a bilateral erector spinal plane block was done before induction of total intravenous general anesthesia.

Results The surgery lasted 2 hours, and the patient remained hemodynamically stable. As a multimodal analgesia strategy, she received dexamethasone, acetaminophen, ketorolac, and ketamine. At the end of the surgery, the patient woke up comfortable and only needed a small bolus of intravenous morphine in the immediate post-operative period. She was evaluated by an anesthesiologist at 24 hours, with only mild pain with movement.

Conclusions Peripheral nerve blocks (PNB) are a possible alternative when it’s decided to not perform an epidural block for laparotomies. By doing so, we can achieve a multimodal analgesic strategy without the risks associated with neuraxial approaches. In this case, we were able to provide comfort for the patient by resorting to less common PNB.