Background and Aims Described by Forero et al, the Erector Spinae Plane Block (ESPB) is a multidermatomal sensory block that provides regional anesthesia to the ipsilateral thoracic or abdominal wall.

We report two cases of Enhanced Recovery laparoscopic after sigmoidectomy converted to laparotomy, combining multimodal analgesia with bilateral ESPB for postoperative analgesia.

Methods The plan was general anesthesia with minimal stress surgery care; using opioid free anaesthesia, dexmedetomidine, dexamethasone and NSAID. Early in the procedure, the surgeon converted to open surgery so we decided to keep the ERAS protocol with a bilateral ESPB which would ensure more comfort.

The ultrasound-guided injection of a long acting local anaesthetic between the erector spinae muscle and the transverse spinal process is followed by the placement of a catheter for continuous infusion (L-bupivacaine 0.125% at the rate of 6 ml/h).

Results The ERAS protocol was ensured. The Numerical Rating Scale scores were always below 3/10 except on day 2, at the withdrawal of the catheter relieved by 5 mg of oxycodone. No nausea or vomiting were reported. (Table 1)

Conclusions Bilateral ESPB is a safe technique with no major side effects compared to the epidural. It gives good quality analgesia and it provides a faster recovery with early standing so a good option in converted abdominal surgery. Prospective randomized trials are needed to confirm the apply of this block.