Background and Aims Colorectal surgery has evolved to laparoscopic procedures with long-acting spinal anaesthesia and intrathecal opiates over epidural anaesthesia . This has become the standard for enhanced recovery programmes across the world with good post-op analgesia . However, due to the longer duration of action of spinal bupivacaine, there are increased risks of hypotension, delayed mobilisation and urinary retention . This case-series presents the use of a short-acting prilocaine spinal anaesthetic in combination with intrathecal opiates and abdominal wall blocks, which successfully provide sufficient analgesia whilst promoting enhanced recovery in laparoscopic colorectal surgery.
Methods Twenty patients undergoing laparoscopic colorectal surgery were included. These patients received 3 ml of intrathecal 2% hyperbaric prilocaine combined with 500micrograms of diamorphine combined with rectus sheath and transversus abdominis plane (TAP) blocks with 80 ml 0.125% levobupivacaine as part of the enhanced recovery protocol.
Results Intraoperatively, patients were observed to be more haemodynamically stable and post-operatively, all patients’ blood-pressure readings had returned to pre-operative levels without the need for any vasopressor support. In the recovery area they were comfortable, with pain scores of 0, and were able to sit-up and ambulate faster without any vasovagal episodes.
Conclusions We have successfully shown that the action of prilocaine can be prolonged by the addition of multimodal analgesia including long-acting interfascial plane blocks. We suggest that it’s use offers increased haemodynamic stability and earlier patient mobilisation post-operatively. This modified technique allows excellent long duration analgesia without the side effects of a long-acting spinal block and makes it more favourable in modern enhanced recovery programmes.
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