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#36353 Exploratory laparotomy with bilateral erector spinae plane block and ‘ketodex’ sedoanalgesia
  1. Ana Inês Proença Pinto,
  2. Fernando Fernando Almeida e Cunha,
  3. Miguel Coelho and
  4. José Nuno Figueiredo
  1. Serviço de Anestesiologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal


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Background and Aims We present the anaesthetic management of a severely frail patient who underwent urgent exploratory midline laparotomy under bilateral erector spinae plane block (ESPB) and ‘Ketodex’ sedoanalgesia. ESPB can result in both visceral and somatic abdominal analgesia. Literature narrows ESPB to multimodal analgesia. However, some cases of ESPB as primary anaesthetic in abdominal surgery have been reported.

Methods A severely frail 87 yo women underwent inguinal hernioplasty with small bowel resection. At day 6, anastomosis dehiscence was suspected, and urgent exploratory midline laparotomy ensued. General anaesthesia was not considered ideal due to poor physical status and expected difficult ventilatory weaning. Neuraxial anaesthesia was not considered due to coagulopathy and thrombocytopenia. We proceeded with a bilateral ESPB injecting 30 mL of 0,5% Mepivacaine + 0,5% Ropivacaine deep to the erector spinae muscle in each side, at T9 level. We associated sedoanalgesia with bolus doses of a Ketamine and Dexmedetomidine mixture as needed, taking advantage of the opioid-free analgesia.

Results No anastomotic dehiscence was confirmed intraoperatively, and conversion to general anaesthesia was not needed. The patient maintained haemodynamic stability and spontaneous ventilation. Pain or discomfort was not reported during the procedure and no adverse events were recorded perioperatively.

Abstract #36353 Figure 1

Intraoperative picture showing the surgical approach after bilateral ESPB and the respiratory and hemodynamic profile (right)

Abstract #36353 Figure 2

Ultrasound-guided bilateral ESPB, demonstrating cranial-caudal local anesthetic (LA) spread in the ESP. Left side picture represents the ESPB performed on the left side. Right side picture represents the ESPB performed on the right side

Conclusions ESPB is a feasible alternative anaesthetic technique for abdominal surgery in frail and severely ill patients, as demonstrated in this case. The synergic combination of dexmedetomidine and ketamine provides effective sedation and potentiates analgesia with a safe respiratory and hemodynamic profile.

  • Erector spinae plane block
  • ‘Ketodex’
  • exploratory laparotomy

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