ABSTRACT
Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.
Subject(s)
Aged , Humans , Male , Abdominal Wall , General Surgery , Anesthesia, Conduction , Methods , Anesthesia, General , Colostomy , Methods , Conscious Sedation , Methods , Dexmedetomidine , Fentanyl , Hemodynamics , Ketamine , Laparoscopy , Nerve Block , Methods , Pain, Postoperative , Postoperative Period , Propofol , Pulmonary Embolism , Reoperation , Methods , Tachycardia, Supraventricular , Ultrasonography, InterventionalABSTRACT
ObjectiveTo compare the efficacy and side effects of ilioinguinal/iliohypogastric nerve blockades and rectal paracetamol after pediatric inguinal hernia repair.MethodsNinety children undergoing half inguinal hernia repair were randomly divided into 3 groups:nerve block group(n=30),paracetamol group(n=30) and control group(n=30).After basal anesthesia,ilioinguinal/iliohypogastric nerve blockades was administed in nerve block group,paracetamol group received rectal paracetamol,control group had not any medication.Every child was oberserved 1,3,6,8 h postoperatively for pain score,overall satisfaction were evaluated by parents,furthermore,evaluation of distress for children such as nausea,vomiting and delayed femoral nerve palsy was made.ResultsPain scores were significantly lower in nerve block group and paracetamol group during the postoperative follow-up 1,3 and 6 h.Overall satisfaction in nerve block group and paracetamol group were significantly higher than control group.The incidence of delayed femoral nerve palsy in nerve block group was higher than paracetamol group(F=4.22P