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ULTRASOUND-GUIDED QUADRATUS LUMBORUM BLOCK; INTRAOPERATIVE AND POSTOPERATIVE ANALGESIC TECHNIQUE FOR OPEN APPENDECTOMY AFTER LAPARASCOPY ATEMPT AFTER AN ALLERGIC REACTION TO SUFENTANYL
Author(s): ,
Fućak Primc, A.*
Affiliations:
Clinical Hospital Centre Rijeka, Anesthesia - Resusitation and Intensive care, Rijeka, Croatia
,
Sotošek Tokmadžić, V.
Affiliations:
Faculty of Medicine- Universitiy of Rijeka, Anesthesia - Resusitation and Intensive care, Rijeka, Croatia
,
Duhović, Đ.
Affiliations:
Clinical Hospital Centre Rijeka, Anesthesia-Resusitation and Intensive care, Rijeka, Croatia
Protić, A.
Affiliations:
Faculty of Medicine- Universitiy of Rijeka, Anesthesia - Resusitation and Intensive care, Rijeka, Croatia
ESRA Academy. Fucak Primc A. Sep 13, 2017; 190708
Topic: Trunk Blocks
Dr. Ana Fucak Primc
Dr. Ana Fucak Primc

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Abstract
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Background and Aims:

A 22-year old male athlete, ASA 1, without previous known medical history or allergies, was scheduled for emergency laparoscopic appendectomy.

We decided to combine general anesthesia with regional anesthesia technique;ultrasound guided quadratus lumborum block (QLB) for postoperative analgesia.

Methods:

The patient agreed and signed the informed consent form. He was premedicated with midazolam intravenously.We proceeded with the ultrasound guided QLB.The patient was positioned in left lateral position to obtain the view of quadratus lumborum (ql) and transversus abdominis plane approaches of lateral abdominal muscles. Aseptic technique was used. A curvylinear, low frequency probe was used which was placed first in the mid axillary line then the posterior axillary line for the posterior approach. We first visualized the transversus abdominis muscle, then the internal oblique and external oblique forming the aponeurosis and then ql muscle was visualized.
0,25% levobupivacaine 20 ml  was infiltrated  in the posterior fascia of the ql muscle.
After induction of general anesthesia with sufentanyl ,propofol and rocuronium and insuflating the CO2, the patient developed  a rash and hypotension, Antiallergic therapy was administered.Since we performed the QLB, and it was an emergency surgery,the surgeons converted laparascopy to open appendectomy. No further drugs were given intravenously with sevofulrane maintenance.


Results:

The surgery was performed without further analgesia and patient emerged without complications.

Postoperatively he did not require any further analgesia.After 20 hours  he started experiencing pain requiring paracetamol.After one week allergy testing was performed ambulatory and showed positive for sufentanyl and fentanyl.

Conclusions:

 The QLB could be effective for intraoperative analgesia as for postoperative analgesia.

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