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Background and Aims Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery is a difficult and painful procedure which has potential to result in different adverse events such as coagulopathy and post-operative hypotension. Previous studies have demonstrated the efficacy of Thoracic epidural analgesia (TEA) for this procedure however it is associated with hypotension. The aim of the study is to compare the outcomes of continuous erector spinae plane block for analgesia versus thoracic epidural anesthesia.Methods A retrospective cross-sectional study was performed which included adult patients 18 years old and above who underwent HIPEC following cytoreductive surgery. Review of medical records was performed to gather data on post-operative analgesia used (TEA or continuous ESPB), pain outcomes, and adverse events.Results A total of 32 patient records were reviewed. The median Numeric Rating Scale (NRS) score immediately post-operative was 0 for the TEA group and 1 for the ESPB group, with a mean score of 1.1 for TEA and 2.2 for ESPB (p=0.248). At 24 hours post-operative,the median NRS score was 2 for TEA and 0.5 for ESPB, with mean scores of 2.3 and 1.3, respectively (p=0.148). The differences in pain score between groups immediately after surgery and 24 hour post-operatively were not statistically significant. The median total opioid dose was higher in the TEA group (42.4 mg) compared to the ESPB group (31.5 mg), with mean doses of 50.1 mg for TEA and 40.6 mg for ESPB. This difference was not statistically significant (p=0.318). A notable difference was observed in hypotension rates, with 25% of the TEA group experiencing hypotension compared to none in the ESPB group (p=0.033).Conclusions Continuous ESPB and TEA demonstrated equal efficacy in the reduction of postoperative pain among patients who underwent HIPEC following cytoreductive surgery. However, Continuous ESPB showed lower incidence of hypotension, making it a potentially safer option for pain management.