Opioid-free anesthesia—dexmedetomidine as adjuvant in erector spinae plane block: a case series

BACKGROUND: Laparoscopic pain is related to the stretching of the peritoneum and peritoneal irritation caused by insufflation of the parietal peritoneum with carbon dioxide. In 2017, erector spinae plane block (ESPB) was described for management of postoperative pain following open and laparoscopic abdominal surgery. The use of multimodal anesthesia reduces both intraoperative and postoperative opioid use and improves analgesia. The addition of dexmedetomidine to the anesthetic mixture significantly prolongs analgesia, without clinically significant side effects. CASE PRESENTATION: We describe a series of three Caucasian women cases that illustrate the efficacy of bilateral ESPB performed at the level of the T7 transverse process to provide intraoperative and postoperative analgesia for laparoscopic gynecological surgery. CONCLUSION: Further investigation is recommended to establish the potential for ESPB with dexmedetomidine as adjuvant as an opioid-free anesthetic modality in laparoscopic gynecological surgery.