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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims Ultrasound guided ilioinguinal and iliohypogastric block is and exceptional approach for open aorto-iliac thromboembolectomy.
Methods A 77-year-old woman came to the emergency department for acute pain in both lower extremities and chest pain. Physical examination showed absence of pedal pulses and elevation of cardiac troponin I. CT angiography showed thrombosis of the aorta prior to bifurcation in common iliac arteries, bilateral external and internal iliac arteries, bilateral pulmonary thromboembolism with overload of the right cavities and venous thrombosis of the left iliac-femoral axis. Urgent surgery is decided for thromboembolectomy of the terminal aorta and bilateral iliac arteries. We performed ultrasound guided ilioinguinal and iliohypogastric nerve block bilaterally. We administered 20 mL of local anesthesia, 10 ml Lidocaine 0.05% and 10 ml Ropivacaine 0.1%, on each side; it was accurately placed between the transverses abdominis and internal oblique till nerves were surrounded on all sides by the drug.
Results The patient remained pain free from the time of the first surgical incision until the end of surgery for ninety minutes. During the following 24 postoperative hours the patient remained respiratory and hemodynamically stable, pain controlled and and did not present postoperative nausea or vomiting.
Conclusions Open bilateral aortic and iliac thromboembolectomy can be successfully performed by regional ilioinguinal and iliohypogastric nerve block. It avoids hemodynamic and respiratory instability associated with general and neuraxial anesthesia. The ultrasound guided technique helps accurately placing the drug and the amount required to be less, reducing drug toxicity and complications.