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#36493 Transverse abdominis plane block as an analgesic alternative to thoracic epidural in vascular surgery
  1. Javier Nieto Muñoz,
  2. Maria Isabel Medina Torres,
  3. Anton Salagre Tovio and
  4. Inmaculada Luque Mateos
  1. Anaesthesiology and intensive care, Hospital Costa del Sol, Marbella, Spain


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Background and Aims Aortic-bifemoral bypass is a surgery chosen for patients with Leriche syndrome or severe peripheral arteriopathy. This procedure implies a laparotomy supra and infraumbilical. That translates into a severe pain during postoperative period. Therefore, pain management becomes a key pilar for early recovery. Cardiovascular anesthesiologists usually choose low thoracic epidural to control pain. However, the circumstances of some patients make it a non-feasible technique. In those cases, abdominal wall blocks are a valid alternative reducing pain, morbidity and the length of stay in hospital.

Methods We expose a case in which a bilateral transverse abdominis block with a single shot technique was performed on a patient who was elected for aortic-bifemoral bypass.

Results A woman 61 years old is elected for aortic-bifemoral bypass due to Leriche syndrome. In our hospital our gold-standard technique is thoracic epidural at a t10-t11 level. However, in this case she had systemic sclerosis, so we decided to perform a bilateral transverse abdominis block with a posterior approach at the level of Petit´s triangle. We administered levobupivacaine 0,25% with a volume of 40 ml in total. During the first 48 hours in the ICU, she received an elastomeric pump consisting of dexketoprofen, metamizole and ondansetron. She didn’t have irruptive pain either she got any opioid rescue analgesia.

Abstract #36493 Figure 1

Transverse abdominis plane block with a posterior approach towards the Petit´s triangle

Conclusions Bilateral transverse abdominis plane block is a valid alternative to thoracic epidural in aortic-bifemoral bypass. Transverse abdominis plane block with a posterior approach can give a sensory block from T7 until L1.

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