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Croatian Medical Journal, Vol. 66 No. 3, 2025.

Case report, case study

https://doi.org/10.3325/cmj.2025.66.227

The application of paravertebral block for open cholecystectomy in a high-risk patient with an implantable cardioverter-defibrillator: a case report

Miroslav Župčić ; Department of Anesthesiology, Intensive Care and Pain Medicine, Rijeka University Hospital Center, Rijeka, Croatia *
Katarina Tomulić Brusich ; Department of Anesthesiology, Intensive Care and Pain Medicine, Rijeka University Hospital Center, Rijeka, Croatia
Tin Nadarević ; 4Department of Radiology, Rijeka University Hospital Center, Rijeka, Croatia
Sandra Graf Župčić ; Department of Neurology, Rijeka University Hospital Center, Rijeka, Croatia
Viktor Duzel ; Northern Hospital Epping, Melbourne, Victoria, Australia
Gzim Redžepi ; Special Hospital Primamed, Zagreb, Croatia

* Corresponding author.

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Abstract

We present a case of a 57-year-old male patient (Ameri
can Society of Anesthesiologists status IV) undergoing
open cholecystectomy under unilateral thoracic paraver
tebral block (TPVB) and sedation. The patient had severe
heart failure, a reduced ejection fraction of approximate
ly 16%, and an implanted subcutaneous implantable car
dioverter-defibrillator. Using ultrasound, we identified the
thoracic (Th) paravertebral spaces on the right side at four
levels (from Th6 to Th9) and administered 3.5 mL of 0.5%
levobupivacaine per level, for a total of 14 mL. Twenty min
utes after TPVB application, we confirmed sensory block
ade from the Th5 to Th10 dermatomes. Ten minutes into
surgery, during liver capsule retraction, the patient experi
enced some pain (5/10 on the visual analogue scale, VAS).
The pain was successfully treated with rescue analgesia of
10 µg of intravenous (IV) sufentanil and a sedation dose
of 50 mg IV propofol. The surgery lasted 45 minutes and
was completed uneventfully. For continued intraoperative
sedation, we used 10 mg/h remimazolam, maintaining he
modynamic stability. Nine hours after surgery, the patient
reported a VAS pain score of 5 and received 75 mg of IV
diclofenac sodium, with no further analgesia required. The
patient was discharged on postoperative day six. In con
clusion, the application of TPVB combined with remima
zolam sedation could present a feasible anesthetic and an
algesic technique for open cholecystectomy in high-risk
cardiac patients

Keywords

Hrčak ID:

352493

URI

https://hrcak.srce.hr/352493

Publication date:

25.6.2025.

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