# Multimodal Regional Anesthesia Combining Spinal and Erector Spinae Plane Block for Spine Surgery in a High-Risk Patient with Systemic Sclerosis: A Case Report

## TL;DR

A high-risk patient with systemic sclerosis successfully underwent spine surgery using a combination of spinal anesthesia and erector spinae plane block, avoiding general anesthesia and opioid use.

## Contribution

Demonstrates the effectiveness of combining spinal anesthesia and erector spinae plane block for high-risk spine surgery patients.

## Key findings

- Multimodal regional anesthesia minimized respiratory risks in a patient with systemic sclerosis.
- The combination of spinal anesthesia and ESPB provided effective pain control without opioids.
- ESPB served as a valuable adjunct to primary anesthesia in high-risk surgical cases.

## Abstract

The erector spinae plane block (ESPB) is a novel regional anesthesia technique that is increasingly incorporated into multimodal analgesia as part of enhanced recovery after surgery (ERAS) pathways in various surgical procedures, including spine surgery.

We report the successful use of spinal anesthesia (SA), ESPB, and magnesium sulfate in a high-risk patient with systemic sclerosis and pulmonary fibrosis undergoing laminectomy. A multimodal approach was selected due to the patient’s underlying condition. This strategy minimized respiratory complications associated with general anesthesia while providing effective surgical anesthesia and postoperative pain control without opioid-related complications.

Our case highlights the utility of ESPB, not only for postoperative pain management but also as a valuable adjunct to primary anesthesia, especially in high-risk patients.