Background and Aims A 76-year-old patient was scheduled for laparotomic orthosigmoidectomy. The patient’s medical record included type-2 diabetes, dyslipidemia, COPD, venous insufficiency and tachyarrhythmias. He was a smoker of 30 pack years, with cough, hemoptysis, hoarseness and whizzing sounds bilaterally on auscultation. The thoracic x-ray showed a right-lung mass and a left lung atelectasy. The spirometry showed an obstructive pattern.

Methods The medical history of the patient, his clinical state and the severity of the operation made him high-risk for postoperative cardiac and respiratory complications. After the patient’s informed consent and discussion with the surgical team, awake multimodal sedation and analgesia, based on epidural anaesthesia, with local surgical infiltration was selected.

An epidural catheter was placed in T10-T11 space. Test dose of 40mg lidocaine (2 ml) was administered, followed by administration of 8 ml of ropivacaine 0.2mg/ml and 50mcg of fentanyl.

The complementary medications that were administered are shown on the attached charts.

Duration of the surgery was 140 minutes.

Results The patient’s vital signs were stable intraoperatively and the ABGs are shown on the attached chart.

After the surgery, the epidural catheter remained in place for three days keeping a VAS score below 2.

Conclusions The combination of epidural anaesthesia, surgical field infiltration and opioid-sparing drugs could achieve an acceptable level of sedation and analgesia, for the performance of a laparotomic orthosigmoidectomy in a high risk patient, with a good level of postoperative pain management and avoidance of postoperative respiratory complications.