Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block

Abstract

Multimodal anesthesia, which combines general and epidural anesthesia, is used in surgical cases in which a large or painful incision is anticipated. However, both epidural blocks and opioid-based analgesia have limitations in application. Here, we present a case of supra-infraumbilical laparotomy in a patient whose history of neurostimulator use and marked scoliosis discouraged the placement of an epidural catheter and whose prior adverse response to opioids prohibited their use. e intraoperative and postoperative management of this patient consisted of a combination of analgesia without opioids and erector spinae plane block. Adequate analgesia was achieved, and intraoperative or postoperative opioids were not required. is case illustrates the importance of mastering alternative and multimodal analgesia techniques that can be used in place of classical analgesia techniques when classical analgesia techniques are not appropriate.

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

“…In parallel to that, isoflurane in higher concentrations can be used for inducing hypotension especially when used in a balanced anaesthetic technique but sometimes tachycardia, that may accompany its usage, leads to a less controlled hypotension ion and misjudge the adequacy of antinociception [32].…”

The combination of an ultrasound‐guided erector spinae plane (ESP) block and epidural morphine as effective intra‐operative adjuncts to opioid premedication in six dogs undergoing lateral thoracotomy

“…12,13 However, the technique itself and the epidural administration of local anaesthetics may have certain complications and contraindications. 12,14,15 In dogs, these can include mechanical or chemical injury of the spinal cord, motor function impairment, and sympathetic blockade leading to hypotension. 12 Vomiting has also been…”

“…Thoracic epidural catheter is the “gold standard” analgesic technique in humans, 11 and its effectiveness in providing analgesia in lateral thoracotomies has also been reported in veterinary medicine 12,13 . However, the technique itself and the epidural administration of local anaesthetics may have certain complications and contraindications 12,14,15 . In dogs, these can include mechanical or chemical injury of the spinal cord, motor function impairment, and sympathetic blockade leading to hypotension 12 .…”

“…25 The erector spinae muscles include the iliocostalis, spinalis and longissimus muscles, all covered by a common fascia. 25 Post-operative analgesia for lateral thoracotomy 6,[26][27][28] and intra-operative analgesia for lumbar spinal 29,30 and abdominal surgery 15,31,32 are some of the indications reported for the performance of the ultrasound-guided ESP block in humans. The reported indications for the use of the ultrasound-guided ESP block in veterinary medicine are the provision of intraoperative analgesia for laminectomies, hemilaminectomies and vertebral fractures.…”

“…12,13 However, the technique itself and the epidural administration of local anaesthetics may have certain complications and contraindications. 12,14,15 In dogs, these can include mechanical or chemical injury of the spinal cord, motor function impairment, and sympathetic blockade leading to hypotension. 12 Vomiting has also beenThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.…”