Opioid-free recovery after laparoscopic-assisted redo pull-through and loop ileostomy via sacral and thoracic erector spinae plane blocks

Abstract

Multi-modal analgesia with a reduction in perioperative opioid use has been a goal for many institutions due to the ongoing opioid epidemic. A reduction in opioid use can also limit undesirable side effects such as nausea, respiratory depression, and ileus in the perioperative and postoperative periods. In this case report, we describe a child who had excellent pain control for colorectal surgery after receiving a novel sacral erector spinae plane block (ESPB) along with bilateral thoracic ESPB's with sustained-release liposomal bupivacaine (Exparel). While there is ample literature describing the efficacy of thoracic and lumbar ESPB's for post-operative analgesia, there is a paucity of information regarding the sacral approach to the ESPB when combined with liposomal bupivacaine and its application to perineal, perianal, and colorectal surgery.

Keywords

• Sacral erector spinae plane block
• Sacral multifidus plane block
• Pediatric regional nerve block
• Liposomal bupivacaine
• Exparel
• Multimodal analgesia