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POSTOPERATIVE ANALGESIA THROUGH QLB 1BLOCK IN A PATIENT AFFECTED BY ACUTE HEMORRHAGIC PANCREATITIS.
ESRA Academy. Fusco P. Sep 8, 2016; 138262; 0084 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Pierfrancesco Fusco
Dr. Pierfrancesco Fusco

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Abstract
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Background and Aims:

The treatment of acute pancreatitis is controversial and debated, if historically opioid drugs were not recommended for the risk of spasm effect on the sphincter of Oddi, currently this risk is resized, therefore, appears appropriate the use of loco-regional anesthesia techniques. QLB 1Block, indeed, provide an  somatic analgesia from T4 to L1 whit posterior approach.

Methods:

We report our experience in the analgesic post operative treatment in a 46 years hold patient, affected by acute  pancreatitis, feverish (38.5°C), tachycardic, with hypotension, undergoes to  explorative  xifo-pubic laparotomy. We decided to not use a opioid drugs, morover, considered the haematic effusion nature, we did not dispense FANS. A QLB 1 block with bilateral approach was performed after the surgical procedure, by injecting 20ml Levobupivacaine 0,375% in each side. We also administred a paracetamolo 30’ before the end of the procedure.

Results:

This technique provided an optimal pain control. Pain has not been reported for the first 24 h (NRS=1) after  it was of  light intensity (NRS= 2-3) in the following 12 h.

Conclusions:

The pain was controlled both in the somatic and visceral component. Several studies have highlighted the overlap of somatic and visceral afferences in the dorsal horn of the spinal cord, furthermore, the QLB 1 approach to the loins area compared to the mid-axillar one allowed the spread of local anesthetic toward the paravertebral space providing a better coverage of visceral pain.

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