372 posters, 1 audios, 13 topics, 29 sessions, 1,035 authors, 449 institutions

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

April 16 - 18, 2026 | Phoenix, Arizona

2318708

Opioid-Sparing Pain Control in Acute Pancreatitis Using a Single-Shot Erector Spinae Plane Block

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Poster Presenter

Antonio Pereira

Authors

Antonio Pereira, Dominique Williams, Elizabeth Kasparov, Oktay Shuminov

Affiliations

Northwell, Northwell Health

Part of Topic

Medically Challenging Cases

Background

Gastrointestinal diseases account for over $119 billion dollars in annual healthcare costs in the United States (U.S.).
Acute pancreatitis is one of the leading causes of gastrointestinal related inpatient admissions in the US, accounting for over 300,000 annual admissions.
Acute pancreatitis is commonly treated with opioid analgesia, which carries risks of adverse effects and prolonged hospitalization.
Regional anesthesia techniques such as the Erector Spinae Plane Block (ESPB) offer opioid-sparing alternatives for persistent abdominal pain in patients with pancreatitis.
Although use of Erector Spinae Plane Block is described in patients with postoperative and chronic pain, evidence in acute pancreatitis remains limited.
We present a case of analgesia and opioid cessation after ESPB in acute-on-chronic pancreatitis

Case Presentation

A 43-year-old Female with a past medical history of chronic pancreatitis with pancreatic stent, pancreatic divisum, anorexia nervosa with binge-purging, major depressive disorder, anxiety, gastroesophageal reflux disorder and chronic hyponatremia secondary to psychogenic polydipsia presents with acute left lower quadrant abdominal pain with associated nausea, vomiting and fever.
A CT abdomen and pelvis with intravenous contrast highlighted a mild increase in a previously visualized fluid collection around the pancreatic tail.
Before evaluation by the inpatient Pain Service, the patient was placed on hydromorphone 2mg/4mg tablets every four hours as needed for moderate/severe pain and hydromorphone 1 mg IV push every four hours for breakthrough pain.
Despite initial pain regimen patient continued to have persistent pain; given no relief and concern for opioid-related adverse effects, a single-shot erector spinae plane block was offered and accepted.
18 mL of Bupivacaine 0.25% and 2 mL of Dexamethasone 5 mg preservative-free were drawn up into a 20 mL syringe.
Using ultrasound guidance and identifying the lower border of the scapula as a landmark for T7, the T8 spinous process was located. Approximately 4 mL of Lidocaine 1% was utilized as local anesthesia. A 22 gauge 80 mm Pajunk needle was then introduced, in plane, and 15 mL of a Bupivacaine 0.25% and dexamethasone 5 mg preservative-free mixture was injected (Figure 1).
Pre-block, the patient reported 9 out of 10 pain. Immediately post block, patient reported pain to be 3 out of 10.
The inpatient opioid regimen was discontinued after intervention and the patient did not require additional modalities for analgesia.
The patient was observed for an additional 24 hours inpatient and was discharged with resolution of symptoms.

Discussion

The case highlights the potential role of the Erector Spinae Plane Block in managing pain secondary to acute pancreatitis while avoiding systemic opioid-related adverse effects.
Although most literature emphasizes catheter-based or repeated ESPBs, this cases demonstrates that a solitary block can provide significant and sustained pain relief.
Given the Erector Spinae Plane Block simplicity, safety profile, and versatility, it may serve as a practical adjunct to traditional pharmacologic strategies, especially in patients with contraindications to Traditional methods

References

Peery, A. F., Dellon, E. S., Lund, J., Crockett, S. D., McGowan, C. E., Bulsiewicz, W. J., Gangarosa, L. M., Thiny, M. T., Stizenberg, K., Morgan, D. R., Ringel, Y., Kim, H. P., DiBonaventura, M. D., Carroll, C. F., Allen, J. K., Cook, S. F., Sandler, R. S., Kappelman, M. D., & Shaheen, N. J. (2012). Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 143(5), 1179–1187.e3. https://doi.org/10.1053/j.gastro.2012.08.002
Adi, O., Fong, C. P., Ahmad, A. H., Ghani, M. R. A., & Fathil, S. (2025). Erector spinae plane block for acute pain management of pancreatic cancer at the emergency department. The ultrasound journal, 17(1), 56. https://doi.org/10.1186/s13089-025-00461-1
Altıparmak, B., Korkmaz Toker, M., Uysal, A. I., Kuşçu, Y., & Gümüş Demirbilek, S. (2019). Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. Journal of clinical anesthesia, 57, 31–36. https://doi.org/10.1016/j.jclinane.2019.03.012
Elkoundi, A., Eloukkal, Z., Bensghir, M., Belyamani, L., & Lalaoui, S. J. (2019). Erector Spinae Plane Block for Hyperalgesic Acute Pancreatitis. Pain medicine (Malden, Mass.), 20(5), 1055–1056. https://doi.org/10.1093/pm/pny232
Elshal, M. M., Gamal, R. M., Ahmed, A. M., Gouda, N. M., & Abdelhaq, M. M. (2021). Efficacy of adding dexmedetomidine as adjuvant with bupivacaine in ultrasound-guided erector spinae plane block for post thoracotomy pain: Randomized controlled study: Dexmedetomidine as adjuvant in ESPB for PTP. Egyptian Journal of Anaesthesia, 37(1), 425–431. https://doi.org/10.1080/11101849.2021.1975973
Peery, A. F., Crockett, S. D., Barritt, A. S., Dellon, E. S., Eluri, S., Gangarosa, L. M., Jensen, E. T., Lund, J. L., Pasricha, S., Runge, T., Schmidt, M., Shaheen, N. J., & Sandler, R. S. (2015). Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology, 149(7), 1731–1741.e3. https://doi.org/10.1053/j.gastro.2015.08.045
Krishna, S. G., Kamboj, A. K., Hart, P. A., Hinton, A., & Conwell, D. L. (2017). The changing epidemiology of acute pancreatitis hospitalizations: A decade of trends and the impact of chronic pancreatitis. Pancreas, 46(4), 482–488. https://doi.org/10.1097/MPA.0000000000000783