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The application of paravertebral block in high-risk patient with cardiorespiratory, liver and kidney problems: a case report

MIROSLAV ŽUPČIĆ orcid id orcid.org/0000-0002-1989-7255 ; Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
SANDRA GRAF ŽUPČIĆ ; Clinic of Neurology, University Hospital “Sv. Duh”, Zagreb, Croatia
ANA BRUNDULA ; Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
IVA KOREČIĆ ZRINJŠČAK ; Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
JASMINKA PERŠEC orcid id orcid.org/0000-0002-3777-8153 ; Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
INO HUSEDŽINOVIĆ1 ; Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia


Puni tekst: engleski pdf 1.495 Kb

str. 307-309

preuzimanja: 554

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Sažetak

Background and Purpose: We present a case report of a patient of the
American Society of Anesthesiologists’ (ASA) IV scheduled for a modified
radical mastectomy (MRM) due to malignant disease. The patient was a
high risk patient for general anesthesia and we opted for the application of
unilateral paravertebral block on several levels. Case report. A 86-year-old
female was scheduled for a surgery due to recurrent malignant process on
her right breast. She was an ASA IV patient with chronic obstructive pulmonary disease (COPD GOLD A), respiratory failure, diabetes mellitus,
diabetic nephropathy, cirrhosis and chronic laryngitis. Echocardiography
showed diastolic dysfunction and pulmonary hypertension of moderate degree. During the preparation for the surgery, an invasive blood pressure
measurement was set while the paravertebral space was identified with the
neurostimulator using the linear ultrasound probe of 8 Hertz (Hz). The
anesthetic [0.5% Levobupivacaine (Chirocaine®, Abbott Laboratories)] was applied in levels of Thoracic (Th) 2, Th3, Th4 and Th5 (5 milliliters(ml.)
per level). We used 2% lidocaine [Lidocaine®, FC] for local infiltration at
the site of the block.

Results: Sensory blockade occurred after 32 minutes (min.) and lasted
for about 8 hours (h) with normal perioperative period and hemodynamic
parameters without accompanying complications.

Discussion and Conclusion: This case report shows that the application
of paravertebral block with lower doses of long-acting local anesthetic
at several levels leads to a satisfactory anesthetic and analgesic effect while maintaining hemodynamic stability.

Ključne riječi

Hrčak ID:

143070

URI

https://hrcak.srce.hr/143070

Posjeta: 890 *