# Erector Spinae Plane Block in Open Appendectomy: A Case Series

## TL;DR

This case series explores the use of erector spinae plane blocks to reduce opioid use during and after open appendectomy surgeries.

## Contribution

The study demonstrates the potential of ESPB to provide opioid-sparing analgesia in open appendectomy.

## Key findings

- Both patients reported minimal pain scores in the PACU without opioid use.
- One patient remained pain-free until discharge with no morphine required.
- ESPB may enable total morphine-free analgesia during and after open appendectomy.

## Abstract

Background: Open appendicectomy is a painful procedure requiring multimodal analgesia. Various fascial planes have been used successfully in the past as part of this multimodal analgesia like TAP block, quadratus lumborum block, and even local infiltration. All of these analgesic regimes have been shown to reduce intra- and postoperative opioid consumption. In this case series, we elaborate on the effects of ESPB on the consumption of opioids in the intra- and postoperative periods of two patients undergoing open appendicectomy.

Case Series: Two American Society of Anesthesiologists (ASA) Emergency (1E) patients scheduled to undergo open appendicectomy were consented to receive ESPB after receiving GA. The block was performed at the transverse process at T12 level, on the right side with 30 mLs of 0.25% levobupivacaine. One patient received intra-op IV paracetamol and ketorolac, while the other patient did not receive paracetamol as he already received it in the ward and ketorolac was withheld due to high creatinine. The surgeries went uneventful. Both patients reported 0 NRS pain score in PACU. One of the patients recorded 0 NRS pain score till discharge, and the other reported an NRS score of 5/10 at 19 h 30 min. Both were discharged from the hospital after 24 h.

Conclusion: ESPB has a potential opioid sparing effect and can provide a total morphine free analgesia both in the intra- and postoperative period in the setting of an open appendicectomy.