Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 08 1510 1510 Shrutika Borikar Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India. Sangeetha Arunachalam Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India. 2025 12 03 2025 12 08 Elderly diabetic patients undergoing emergency colorectal surgery present significant anesthetic and analgesic challenges. Thoracic epidural analgesia is considered the gold standard for postoperative pain control; however, refusal or contraindications may necessitate alternative techniques. This case describes the use of a WHO pain ladder–guided intravenous multimodal analgesic strategy in a 71-year-old patient undergoing Hartmann’s procedure. Stepwise escalation of non-opioid, weak opioid, and strong opioid analgesics allowed effective intraoperative pain control, hemodynamic stability, and minimized postoperative opioid requirements. https://aacc.tums.ac.ir/index.php/aacc/article/view/1510