Ultrasound-guided bilateral paravertebral continuous nerve blocks for a mildly coagulopathic patient undergoing exploratory laparotomy for bowel resection.
Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications. The patient expressed satisfaction with his pain control. More studies are needed to evaluate the validity of TEG in the prediction of bleeding risk and the safety of this regional technique in a mildly coagulopathic patients.
Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA. m_visoiu@yahoo.com
Mihaela
M
Visoiu
Charles
C
Yang
D000293:Adolescent; D015360:Analgesia, Epidural; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000628:therapy; D001780:Blood Coagulation Tests; D002404:Catheterization; D030321:Denys-Drash Syndrome / Q000150:complications / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D016030:Kidney Transplantation; D007813:Laparotomy / Q000379:methods*; D008297:Male; D009392:Nephrectomy; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D014463:Ultrasonography