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Background and Aims Placenta accreta spectrum (PAS) denotes a range of conditions with pathologic infiltration of trophoblastic and villous tissue resulting in higher rates of adverse maternal outcomes (1).The primary aim of this study was to review the anesthetic management of PAS at our institution.Methods This review was performed in a large tertiary centre in North America with two major sites that facilitate 6,800 deliveries annually. We conducted a chart review of PAS cases at our institution from 2019–2024.Results Thirty-nine cases were included, and relevant perioperative information is included in table 1. Thirty-five patients received epidurals with the level ranging from T7-L5 to allow for a midline incision, exteriorization of the uterus and fundal extrication of the fetus. The most common epidural level administered was T10-T11 (8), followed by L3-L4 (6) and L2-L3 (5). The highest pain scores experienced in recovery were recorded (0–10). For those with an epidural at T10–11, the mean pain score was 3.88, 4.6 for L3–4 and 2.25 for L2-L3. The average time to breakthrough analgesia was 95 minutes, with 35% of patients not requiring breakthrough pain medications, and 56.76% of patients not requiring opioids in recovery. The most common complication intraoperatively was a bladder cystotomy (6), and post-operatively was an ileus (4). Nine patients returned to hospital within 90 days (23%), and five were re-admitted.Abstract OP71 Table 1Conclusions PAS at our institution was primarily managed with a general anesthetic, and epidural anesthesia for post-operative pain control. We hope to use this data to perform subgroup analysis and compare to other centres.