Resolved PVB for Laparoscopic Cholecystectomy?

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?

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

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