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Erector Spinae Plane Block: A New Twinkling Star Ready To Create Wonders in Toddler’s Spine Surgeries - A Case Report

Aims: The expanded horizon of the ultrasound-guided erector spinae plane block (ESPB) shows promising results in various surgeries involving the thoracic, abdominal, pelvic, joint, and spine regions. We aimed to administer ESPB in spine surgery of the early pediatric age group patient to reduce the overall requirement of the intraoperative general anesthetic drugs and postoperative opioids due to high analgesic demands. 
Presentation of Case: We report the application of ultrasound-guided bilateral ESPB as multimodal analgesia (MMA) component in the spine surgery of the youngest (2-year old) age group. 
Discussion: Spine surgeries, especially scoliosis surgeries, are associated with extensive surgical dissection, leading to significant postoperative nociception causing high analgesic demands and necessitating high opioid consumption. It further leads to opioid-related side effects, delay in discharge, late ambulation, and prolonged hospital stay. 
The ESPB potentially helps in controlling polypharmacy by providing wide multisegmented analgesic coverage due to its multidirectional drug spread pattern. There are upcoming concerns regarding anesthesia-induced developmental neurotoxicity and the detrimental effect of general anesthesia in developing children. Such concerns can be addressed by cutting down the requirement of general anesthetic agents to a minimum level with the help of modalities like MMA incorporating regional analgesia (RA) as an adjunct. 
Conclusion: The ESPB can be a safe and effective adjunct to the MMA in providing opioid-free optimal analgesia in spine surgery of the youngest population.