[Ultrasound-guided subcostal and mid-axillary transverus abdominis plane block: a cadaveric study of the spread of injectate].

BACKGROUND: Mid-axillary transversus abdominis plane block (TAP-B) and subcostal TAP-B have become well-known blocks to provide considerable analgesia for abdominal surgery. However, proper approach and adequate volume of injectate have not still been clarified. In this study, a combination of mid-axillary TAP-B and subcostal TAP-B was performed in cadavers to establish the spread of injectate and segmental nerve involvement. METHODS: Ultrasound-guided dye injections (10 ml each) into the TAP were performed with mid-axillary and subcostal approaches. Injections were performed for hemiabdominal walls of 4 Thiel's embalmed human cadavers. Dye spread and nerve involvement were evaluated by dissection 10 min after the injections. RESULTS: All 7 hemiabdominal walls were successfully injected and dissected after 1 pilot study. Thoracic nerves (T7-12) and the first lumbar nerve (L1) were found. Segmental nerves T7 (14%), T8-11 (100%), T12 (71%), and L1 (43%)were involved. CONCLUSIONS: This study demonstrated that the combination of ultrasound-guided mid-axillary TAP-B and subcostal TAP-B involve T8-L1 nerves. This technique can be used not only in lower abdominal surgery but also in upper abdominal surgery.

[Successful life saving from brachiocephalic vein injury using cardiopulmonary bypass during video-assited thoracoscopic resection for a mediastinal tumor--a case report].

A 67-year-old man was scheduled for video-assited thoracoscopic resection of a mediastinal tumor under epidural and general anesthesia. During removal of the tumor about an hour 30 minutes after the start of the operation, pulseless electrical activity developed due to uncontrollable massive hemorrhage caused by laceration of the left brachiocephalic vein. After intravenous administration of epinephrine and fluid resuscitation, compatible red cell transfusion with a different ABO group and intraoperative autotransfusion were started. Hemodynamics was unstable although bleeding was stanched. Therefore, cardiopulmonary bypass (CPB) was initiated about 2.5 hours after blanching had started. As a result, bleeding from the laceration was reduced, and the laceration was repaired. The patient recovered uneventfully and had no complications. CPB should be considered for cases of uncontrollable bleeding from a central vein and should be initiated as soon as possible.

[Usefulness of preoperative epidural catheterization under radiographic monitoring in anesthesia for endovascular abdominal aneurysm repair].

In Japan, endovascular abdominal aneurysm repair became one of the standard procedures in 2006. It has been performed in 8 patients at our hospital. We try epidural anesthesia with sedation for treatment because of the good control of blood pressure and immobilization of the patient. We usually perform epidural catheterization one day before the operation to avoid epidural hematoma due to heparinization during the operation. We usually use radiographic monitoring for safe and precise insertion of the catheter into the epidural space. Epidural catheterization with radiographic monitoring is useful for safe and reliable epidural analgesia.