Background and aims Esophagectomy is indicated for both malignancies and benign disorders. It usually involves midline thoracotomy and laparotomy.1 Epidural analgesia has been implemented over the years if no contraindications exist.2
Methods The patient was 55 years old, with BMI 19.53 kg/m2. She suffered from neuromotor dysfunction of the esophagus reluctant to medical treatment, therefore she was scheduled for open esophagectomy. She was on sertraline for depression and had no other comorbidities. Due to the nature of the procedure she was offered an epidural for postoperative analgesia which she refused. She was alternatively offered a combination of nerve blocks under ultrasound guidance.3 4
Results Induction was carried out with fentanyl 100mcg, propofol 150 mg and rocuronium 30 mg for facilitation of endotracheal intubation. Following induction a CVP and an arterial line were inserted. Subsequently, a bilateral QLB II block and a bilateral PECS II block were carried out. Due to patient’s weight, levobupivacaine was diluted to 0.125% and 20 ml for each PECS block and 25 ml for each QLB block were administered, equaling a total amount of 90 mls. 1 g of paracetamol and 6 mg of morphine were also given.
Conclusions The procedure lasted 7 hours. Blood loss was 2 litres and the patient was transfused with 2 units of RBC. She was transferred asleep to HDU and woke up 4 hours later after postoperative haemodynamic stability was confirmed. She woke up feeling comfortable with a VAS score of 3/10. Combined QLB and PECS blocks can be a part of multimodal analgesia for extended thoracoabdominal incisions when epidural anaesthesia is not desirable.
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