• Richard J Gawel, Jeffrey A Kramer, Nova Panebianco, Michael Gottlieb, Frances S Shofer, and Michael Shalaby.
• Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: richard.gawel@pennmedicine.upenn.edu.
• Am J Emerg Med. 2025 Jan 16.

BackgroundGastrointestinal symptoms of acute opioid withdrawal are distressing for patients and are often difficult to manage with conventional therapies. Insufficiently managed opioid withdrawal symptoms may lead patients to leave against medical advice, which can increase their risk of relapse and result in poor outcomes from untreated conditions. We assessed the impact of an erector spinae plane block on the acute gastrointestinal symptoms of opioid withdrawal.Case ReportA 44-year-old woman with opioid use disorder presented to the ED with severe gastrointestinal symptoms of opioid withdrawal, refractory to parenteral opioid agonists and symptomatic treatment. She underwent an ultrasound-guided erector spinae plane block with 30 mL of 0.25 % bupivacaine which completely resolved her gastrointestinal symptoms.ConclusionThrough blockade of the sympathetic chain, the erector spinae plane block could provide targeted symptomatic relief for patients presenting with severe gastrointestinal symptoms of opioid withdrawal. Future research should seek to evaluate the efficacy observed in this case in larger patient populations.Copyright © 2025 Elsevier Inc. All rights reserved.

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