Enhanced Recovery with Erector Spinae Plane Block in Hepatobiliary Surgeries: A Case Series.

Introduction : The erector spinae plane (ESP) block is a novel technique for post-operative pain management in abdominal surgery. Perioperative analgesia provision is an essential component of ERAS (Enhancing Recovery after Surgery) pathways, which aim to improve recovery, reduce opioid consumption, and facilitate early mobilization. This case series demonstrates the utility of the ESP block in improving pain control and enhancing recovery in hepatobiliary surgeries, specifically in reducing post-operative pain, opioid consumption, and promoting early functional recovery. Case Reports : This case series reports on various hepatobiliary surgeries, including radical cholecystectomy, pancreatic pseudocyst drainage, Common Bile Duct (CBD) exploration, excision of hydatid cyst of the liver, and exploratory laparotomy for ruptured liver abscess. Pre-emptive ESP blocks were administered at lower thoracic levels using ultrasound guidance. Intra-operative nociceptive monitoring was done using the CONOX® monitor, and post-operative NRS scores were recorded at various time points for 24 hours. Discussion : Significant reduction in post-operative pain scores, decreased opioid requirements both intra-operatively and post-operatively, early ambulation, and shorter hospital stays were observed in all five cases. This demonstrates the potential benefits of the ESP block in improving post-operative pain management and enhancing recovery in patients undergoing abdominal surgery, specifically in the context of hepatobiliary procedures. Conclusion : The ESP block is a valuable adjunct in post-operative pain management for abdominal surgeries, offering effective analgesia, reducing opioid consumption, and facilitating early recovery.