[Case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by transversus abdominis plane block, rectus sheath block, and continuous wound infusion with ropivacaine].
Ultrasound-guided peripheral nerve blocks in the abdominal wall, such as transversus abdominis plane block (TAP block) and rectus sheath block, are now widely used. We report a case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by abdominal wall block and continuous infusion. A 61-year-old man diagnosed with Leriche's syndrome underwent Y-graft replacement for an abdominal aortic aneurysm. Preoperative enhanced and 3-dimensional CTs showed many collateral arterial systems, especially in the right abdominal wall. It was suggested that the right internal iliac artery had been completely occluded, and the left one showed severe stenosis. After the induction of general anesthesia, we recognized collateral arteries through an ultrasound view as on preoperative CTs. We lowered the pulse repetition frequency more than usual in order not to injure them. We injected 0.1875% ropivacaine 60 ml as TAP block, and 20 ml as rectus sheath block. When the wound was closed, a catheter was passed through an 18-gauge Tuohy needle placed above the fascia along the supraumbilical site. After the operation, 0.2% ropivacaine was continuously delivered at a rate of 6 ml hr-1 through the catheter. We could provide the patient with effective analgesia after surgery.
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Arisa
A
Hotta
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Yuuki
Y
Yagi
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Saaya
S
Hakata
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Yae
Y
Tsumura
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Motoko
M
Shimizu
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Ayako
A
Kukida
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Ai
A
Nakamoto
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Noriko
N
Yoshikawa
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Naoko
N
Oohira
Department of Anesthesiology, Sumitomo Hospital, Osaka 530-0005.
Shigeki
S
Tatekawa
D034861:Abdominal Wall / Q000294:innervation*; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D036502:Infusions, Intralesional; D007813:Laparotomy; D007925:Leriche Syndrome / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control / Q000628:therapy*; D000077212:Ropivacaine; D013997:Time Factors; D014463:Ultrasonography
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine