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Background and Aims A 65 year-old male, ASA III with a medical history of etilism, hepatic fibrosis, COPD and acquired haemophilia A presented for a pylorus preserving pancreatoduodenectomy via bilateral subcostal incision. Directly before the surgery, the factor VIII level was not sufficient (only 32%) and based on the recommendation of haematologists the patient could not receive any NSAID or Salycilate. After an uneventful surgery he was transported to the intensive care unit (ICU) in intubated state. During the surgery he hasn’t received any analgesics besides total amount of 150 mcg Fentanyl.
Methods In order to ensure adequate analgesia bilateral external oblique intercostal (EOI) catheter were placed under ultrasound guidance at the ICU, under coagulation factor protection. Once loaded with 20-20 mL of bupivacain 0.2% patient was successfully extubated with 1/10 of VAS pain score. Continuous blocks were accomplished by intermittent boluses in every 12 hours. Sensory deficit (T7-T10) was detected by pinprick test over the upper quadrants of the abdomen. There was no need to apply any additional analgesics. We have prepared a morphine PCA pump, however the patient didn’t use it once. Two hours after the extubation he was sitting in the bed without any discomfort. The patient was released from the ICU on the first postoperative day. The catheters were removed on the 4th day.
Results The applied regional technique resulted in an effective and safe analgesia judged by low pain scores and early mobilization.
Conclusions EOI catheters provided efficient pain relieve after a pancreatic surgery via bilateral subcostal incision.