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Abstract
Background and Aims General anesthesia is commonly preferred in laparoscopic cholecystectomies (LC). However, different anesthesia approaches can be applied in high-risk patients. In this study, we aimed to present a case of a pulmonary high-risk patient who underwent LC with paravertebral block and Quadratus Lumborum-III block (QLB).
Methods The 62-year-old male patient had a history of hypertension, COPD, and previous tuberculosis. The patient‘s test results revealed FEV1 of 49%, FEV1/FVC ratio of 68%. The patient had dyspnea, and computed tomography showed destructive, fibrotic changes and pleural thickening in the lungs. Due to high pulmonary risk, regional anesthesia was planned for this patient. Bilateral paravertebral block (figure 1) and bilateral QLB-III (figure 2) were applied for 30 minutes before the operation at the thoracic 8 level. The patient, who had T4-T12 dermatome involvement, was sedated with 2 mg midazolam and 50 mcg fentanyl, and then taken to the operation room (figure 3). The patient‘s Richmond Agitation Sedation Scale remained at -1 during the operation.
During local anesthetic administration to the paravertebral space, TP: Transverse Process, ESM: Erector Spinae Muscle
Quadratus lumborum III block imaging. TP: Transverse Process, EO: external oblique muscle İO: internal oblique muscle TA: transverse abdominis muscle. TLF: thoracolomber facia
During the operation, the patient and the surgical team
Results The patient was transferred to the ward without any complications or pain after the operation. The patient consumed 4 g of paracetamol, 50 mg of dexketoprofen, and 50 mg of tramadol in postoperative analgesia during 24 hours , and was discharged without any issues at the end of the 24th hour.
Conclusions This case report describes the successful use of Paravertebral and QLB-III in a pulmonary risk patient undergoing LC. We believe that Paravertebral and QLB-III can be a safe and an effective option for regional anesthesia in pulmonary risk patients undergoing LC.