1. Sharon Acheson
  2. General
  3. Tuesday, 23 March 2021
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Hi!

I have a patient listed for a laparoscopic cholecystectomy this week who I want to avoid opioids in for multiple reasons. Would a single shot Paravertebral block at T10/11 (20 mls) be enough? Would you add Clonidine? Would an Erector Spinae Block at the same level be an appropriate plan B?

Thank you,

Sharon

PS I'm very excited about this forum and the chance to ask all my questions!!
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Hi Sharon,

Interesting topic. Not tried to do a lap whole opioid free, but should be entirely possible.
For me, if you've the ability to do a PVB, then this has to be the better option, the sympathetic block will be advantageous. If the body habitus or other reasons prevent this, then an ESP would be a good second choice,
I would consider doing it a fair but higher though, given uppermost port sites are often upper abdominal/subcostal. T7 or above, and bilateral to cover midline.
I see no harm in using other multimodal analgesia in conjunction with either of these options, Clonidine, Ketamine, Mg etc would all be good options.
We've seen a lot of difficult gallbladders at my place recently. Think lockdown (and delayed ops) has led to a bunch of stuck down horrible messes, so your outcomes may be interesting to everyone....

Anyone else got any more first hand experience?
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Hi Simeon,

Thanks very much for your advice. I managed to go opioid free today! I used TIVA with multi-modal (Paracetamol/NSAID/Ketamine/Mg/Dex) and an ESP block at T7 (my first one!). I couldn't get good enough views to do a PVB unfortunately. The patient seemed comfy in recovery but there was no demonstrable block. Do you get a demonstrable block with an ESP??? First dose of PO Morphine 4 hours post op. So I'm not sure if her reasonable immediate post op comfort was due to the block, the quick surgery or multimodal analgesia!

Until next time!

Sharon
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PS I found Amit Pawa's ESP Block video very helpful, thank you!
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