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Abstract
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Background and Aims Colorectal surgery is the main treatment for acute abdominal obstruction, although postoperative pain management is generally inadequate in most patients. It may require large amounts of opioids. This study aimes to evaluate the efficacy of bilateral ultrasound-guided mid-point transverse process to pleura block (MPT-B) in laparotomic surgery, specifically for sigmoid resection.
Waking up after laparotomic colorectal surgery
Methods The procedure is carried out at the San Salvatore hospital in L’Aquila. The patient undergoing colorectal surgery receives general anesthesia with preoperative bilateral ultrasound-guided mid-point transverse process to pleura block using 20ml of 0.25% levobupivacaine + dexamethasone 4mg bilaterally. Intraoperatively, intravenous low dose Remifentanil (0.6 ng/ml in TCI mode), paracetamolo 1gr and Ketorolac 30 mg are administered as part of multimodal analgesia. To complete the post-operative analgesia, Morphine 5 mg and Ondansetron 8 mg are given after waking up. During the post-operative hospitalization, therapy with Contramal 50mg x 3/day is set up for the first 5 days. Data on intraoperative and postoperative analgesic effects and the effect on recanalization after surgery are recorded.
Results During surgery, the patient maintaines hemodynamic stability (PA= 110/60, FC=60 bpm); after waking up NRS=0, in the following 5 days NRS< 3; recanalization on the ninth postoperative day.
Conclusions This case report suggests that, as part of multimodal analgesia, bilateral ultrasound-guided MPT-B after induction may reduce postoperative pain and opioid consumption in patients undergoing laparotomic colorectal surgery.