376 Erector Spinae Fascial Plane Block as a Method of Reducing Postoperative Opioid Consumption Following Laparoscopic Benign Hiatal Surgery: A Pilot Study

Abstract Aim Erector spinae fascial plane block (ESP) is an effective treatment modality in managing postoperative pain following laparoscopic abdominal surgery. Its use following laparoscopic cholecystectomy has been associated with improved postoperative analgesia and respiratory function and reduced opioid consumption. Reducing opioid use following laparoscopic benign hiatal surgery is important in preventing postoperative nausea and vomiting (PONV) which could potentially complicate fundoplication. We report the results of a pilot study of ESP in this patient group. Method A retrospective analysis was conducted of patients undergoing laparoscopic benign hiatal surgery with ESP prior to anaesthetic induction between February and July 2025. Patients received a single weight-dependent bolus of 40ml of 0.25-0.375% bupivacaine with adrenaline (1:200,000) under ultrasound guidance. Outcomes were collected on: postoperative opioid consumption, pain score, PONV, and complications of ESP. Results 7 patients underwent laparoscopic benign hiatal surgery with ESP during the study period. There were no conversions to open surgery. There were no complications directly related to ESP. Median opiate consumption in recovery was 2.5 mg oral oxycodone. No additional paracetamol or NSAID was administered. 57% of patients reported no pain, and no patients were in moderate or severe pain on leaving recovery. No patients reported PONV. Conclusions ESP in patients undergoing laparoscopic benign hiatal surgery appears to be a promising and safe technique. Prospective comparison studies with standard management are required to determine benefit.