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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims A 78 year old female patient was admitted to our hospital with big open wound bellow the knee, size of 25x10cm, that was 3 weeks old. The patient had a history of recent covid respiratory infection, congestive heart failure, mitral valve replacement, hypertension, atrial fibrillation, cerebrovascular insult and chronic renal failure. On the admission proBNP was 15000, she had hypoxemia, and because of artificial valve received therapeutic dose of low molecular weight heparin. It was a challenge to provide anesthesia for surgical intervention and adequate analgesic treatment.
Methods On the day of admission surgeon performed wound debridement in analgosedation with midazolam, fentanyl and propofol, and after the procedure she received paracetamol 500mg q.i.d and diclofenac b.i.d. Patient reported intensive pain, on NRS 6/10, and tapentadol 100mg was given as a rescue medicine. For further anesthesia and analgesia plan, opioid consumption had to be minimized because of respiratory compromise. Administration of central neuraxial anesthesia was ruled out because of coagulopathy.
Results We performed ultrasound (US) guided continuous PNB (cPNB) of sciatic nerve in popliteal fossa for anesthesia and postprocedural pain. Insertion of PNC was performed US guided under sterile conditions. Bolus of 15ml 0,25% Levobupivacaine was injected 30 minutes before debridements for three consecutive days, and for paint therapy infusion pump was connected to perineural catheter with Levobupivacaine solution 0,125% 4-5ml/h for 72 hours. Patient pain on NRS didn’t exceed 3/10.
Conclusions Ultrasound guided cPNB is an excellent anesthetic technique for repeated surgical debridements and effective strategy for pain relief in high risk patients.