Background and Aims Acute abdomen is an emergency requiring immediate surgical intervention, for which midline exploratory laparotomy is the most commonly performed procedure. Although traditionally performed under general anaesthesia in the developed world, general anaesthesia can be challenging in Sub-Saharan Africa due to resource gaps. Therefore, in underdeveloped countries the anaesthetic approach must be frequently adjusted, with regional anaesthesia growing in relevance.
Methods The authors describe the successful use of neuraxial anaesthesia in a 38-year-old female patient with acute abdomen proposed for emergent midline exploratory laparotomy during a medical-humanitarian mission at the Simão Mendes National Hospital in Guinea-Bissau. Considering the scarcity of resources, namely lack of access to functioning anaesthetic machines, basic airway equipment, capnography, and even oxygen cylinders, regional anaesthesia was preferred rather than general anaesthesia. After informed consent, a combined spinal-epidural anaesthesia was performed using a separate needle technique with an initial subarachnoid injection of 2.5 ml of 0,5% bupivacaine and 2.5 µg of sufentanil (L1-L2 level) followed by placement of an epidural catheter (T8-T9 level) for potentially prolonged surgery and postoperative multimodal analgesia. Despite airway security and pulmonary aspiration concerns, the patient remained conscious, on spontaneous ventilation.
Results General anaesthesia was successfully avoided and there was no need for supplemental oxygen therapy or vasopressors, although episodes of vomiting did occur. Intestinal perforation was diagnosed intraoperatively and small bowel resection and anastomosis were performed uneventfully. Postoperative recovery was unremarkable.
Conclusions Neuraxial anaesthesia may be a safe, effective, and less expensive approach for acute abdomen surgery in Sub-Saharan Africa patients under similar circumstances.
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