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SUCCESSFUL MANAGEMENT OF POST-OPERATIVE PAIN WITH BILATERAL SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK CATHETERS FOR TOTAL GASTRECTOMY IN A HYPOTHYROID PATIENT
Author(s): ,
Yeo, S.H.L.*
Affiliations:
Khoo Teck Puat Hospital, Anaesthesia, Singapore, Singapore
Kannan, A.
Affiliations:
Khoo Teck Puat Hospital, Anaesthesia, Singapore, Singapore
ESRA Academy. Yeo L. Sep 13, 2017; 190690
Topic: Peripheral Nerve Blocks

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Abstract
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Background and Aims:

Adequate analgesia for gastrectomy reduces risk of lung atelectasis and pneumonia.  In hypothyroid patients, there is increased risk of sedation and respiratory depression.  In this case report, successful management of a hypothyroid patient who underwent semi-urgent total gastrectomy, Rou-en-Y reconstruction with bilateral subcostal transversus abdominis plane (TAP) block catheters is described.

Methods:

65 year old lady with gastric cancer and acute drop in haemoglobin underwent semi-urgent total gastrectomy, Rou-en-Y reconstruction, with an upper midline incision.  She was diagnosed with hypothyroidism 5 days pre-operatively, with little time for optimization.  Reviewed by Endocrinology: high risk of myxedema coma postoperatively.

Intra-operatively, she received target-controlled remifentanil infusion, maximum rate of 0.5ng/mL.  At the end of surgery, bilateral subcostal TAP block with catheters were inserted using ultrasound guidance.

Post-operatively, the patient was transferred to intensive care unit, where she was kept intubated and sedated overnight.  Infusions of 0.1% ropivacaine at 5mL per hour was started for each TAP block catheter.  The patient was extubated the next day.  Oral analgesics such as paracetamol, etoricoxib and tramadol were given as needed.Results:

The patient was reviewed daily till post-operative day(POD) 4, when the catheters were removed.  There was no pain at rest and mild pain on movement when she was reviewed daily.  She was able to sit out of bed and participate in physiotherapy on POD 2 and ambulate in the ward on POD 3.

Conclusions:

Regional anaesthesia is useful, especially for hypothyroid patients, to reduce risk of sedation and respiratory depression. Hypothyroid patients are likely to have lower analgesic requirements.

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