Due to the significant risk of massive bleeding complicated by profound hypotension and coagulopathy and a high likelihood of hysterectomy during caesarean delivery, general anesthesia is generally regarded as the anesthetic of choice for patients with placenta accreta. The advantage of a planned general anesthetic is the ability to secure the airway in a controlled setting, before the onset of hemodynamic instability, airway edema or coagulopathy. A multidisciplinary approach may improve patient outcomes. However, it is necessary to maintain a good depth of anesthesia and sufficient analgesia and to consider the impact of anesthesia drugs on the fetus.
Since all opioids, particularly those with high lipid solubility (e.g., remifentanil, fentanyl, and sufentanil), readily pass through the placenta to the fetus. Consequently, opioid administration is usually avoided until after delivery to reduce the risk of neonatal depression.
The latest publications have reported that the erector spinae plane block is one of the components of multimodal analgesia techniques for pain management after different surgical procedures, including cesarean delivery.