perioperative Analgesic Effect of Erector Spinae Plane Blocks in Whipple Surgery.

Hepatopancreaticobiliary (HPB) surgery is a major upper abdominal surgery with major hemodynamic changes The standard analgesic regime for major HPB surgery includes thoracic epidural analgesia (TEA), rectus sheath, and subcostal transversus abdominal plane (TAP) blocks with surgically sited TAP catheters at the end of surgery, analgesic adjuncts including paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) when appropriate, and fentanyl-based patient-controlled analgesia (PCA) starting postoperative day.The most recently described alternative to TEA is the erector spinae plane (ESP) block. The ESP block is a facial plane block that aims to inject a local anesthetic agent within a plane beneath the erector spinae muscleAIM :To study the impact of ESP Block on hemodynamic stability and maintenance of intra-operative Analgesia Nociception Index (ANI) accepted range and evaluate the postoperative pain by visual analogue score (VAS), total opioid requirements and incidence of post-operative