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INCARCERATED PARAUMBILICAL HERNIA REPAIR UNDER RECTUS SHEATH BLOCK IN A PATIENT WITH SIGNIFICANT MEDICAL CO-MORBIDITIES
Author(s): ,
Zabauski, D.*
Affiliations:
Health education North West, Anaesthetic rotation, Manchester, United Kingdom
,
Biswas, A.
Affiliations:
Health Education North West, ACCS rotation, Manchester, United Kingdom
Hulgur, M.D.
Affiliations:
Wrightington- Wigan and Leigh NHS Foundation Trust, Anaesthetic Deepartment, Wigan, United Kingdom
ESRA Academy. Zabauski D. Sep 13, 2017; 190707; 365 Topic: Peripheral Nerve Blocks
Dzmitry Zabauski
Dzmitry Zabauski

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Abstract
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Background and Aims:

We describe a case of an open surgical repair of a paraumbilical hernia performed under rectus sheath block.

Methods:

The patient gave his consent for this presentation.

Results:

Mr S was a 75 year old gentleman who was admitted to a medical ward with an infective exacerbation of COPD. His past medical history was significant and included brochiectasis, severe COPD on 24 hours oxygen therapy, atrial fibrillation, pulmonary embolysm. His exercise tolerance was few metres. During the admission he developed abdominal pain and was diagnosed with an incarcerated paraumbilical hernia. Anaesthetic review concluded that he was a very high risk patient for a general anaesthetic. Therefore it was decided to perform the surgery under rectus sheath block. Under ultrasound guidance 10 ml of 0.5% bupivacaine was administered between the rectus abdominis muscle and posterior rectus sheath on each side. The surgeons supplemented the block by infiltrating the skin and subcutaneous tissues with 15 ml 1% lidocaine with adrenaline. A defect about 1 cm was found, the sac contained the omentum and extraperitoneal fat. Intraoperatively the patient was given 1 g IV paracetamol, but no sedation or any further analgesia. He remained comfortable and pain free throughout the surgery.

Conclusions:

Advances in regional anaesthesia have made it possible to anaesthetise patients with significant medical co-morbidities.

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