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Ultrasound-guided transversus abdominis plane block in combination with ilioinguinal-iliohypogastric block in a high risk cardiac patient for inguinal hernia repair: a case report

STJEPAN BARISIN orcid id ; 1_Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb; 2_Faculty of Medicine Osijek, University J.J. Strossmayer Osijek, Croatia
VIKTOR DUZEL ; Department of Anaesthesia and Intensive Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
LIVIJA SAKIC ; 1_Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Sveti Duh, Zagreb; 2_Faculty of Medicine Osijek, University Osijek, Osijek, Croatia

Puni tekst: engleski pdf 1.279 Kb

str. 303-305

preuzimanja: 766



Background and Purpose: A high risk cardiac patient, ASA IV, was
planned for inguinal hernia repair. Since general anaesthesia presented a
high risk, anaesthesia was conducted with a transversus abdominis plane
(TAP) in combination with ilioinguinal-iliohypogastric (ILIH) block.
Material and Methods: A 70-year old male patient with severe CAD
and previous LAD PTCA, AVR, in situ PPM and severe MR and TR 3+,
was planned for elective inguinal hernia repair. The preoperative ECHO
showed IVS dyskinesis with apicoseptal hypokinesis, global EF 42% and
grade III diastolic dysfunction. The patient also suffered from hypertension,
diabetes mellitus and had severe stenosis of both femoral arteries.
Preoperative preparation included IBP monitoring while the TAP block
was carried out under ultrasound guidance using an 8 Hertz linear probe.
The ilioinguinal and iliohypogastric nerves were identified with ultrasound
and peripheral nerve stimulator. Local anaesthetic [0.5% levobupivacaine
(Chirocaine®, Abbott Laboratories) ] was applied in two locations: in the
upper right fascia of the transversus abdominis muscle (15 ml) and around
the right ilioinguinal and iliohypogastric nerves (10 ml), totalling a volume
of 25 ml. Skin infiltration was performed with 5 ml 2% lidocaine [Lidocaine
®, Belupo] and 5 ml of normal saline.

Results: Sensory block onset was at 28 minutes after administration and
lasted for approximately 18 hours. There were no haemodynamic disturbances and the perioperative course was uneventful.

Conclusion: During the first 18 postoperative hours, the patient was
comfortable and satisfied with the anaesthetic procedure.

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