title: Can low dose spinal anesthesia combined with ultrasound guided bilateral ilioinguinal-iliohypogastric nerve blocks avoid use of additional epidural catheter in high risk obstetric cases? Our experience from two cases.
abstract: Critical obstetric cases associated with cardiac pathology may pose real challenge for anaesthesiologist during Caesarean section. Meticulous perioperative care and suitable selection of anaesthesia technique are the key to successful outcome. Single shot spinal anaesthesia is not used any more because of serious haemodynamic consequence. Progressive and controlled epidural local anaesthetic injection is mostly used in such cases. But recently combined spinal epidural anaesthesia and continuous spinal anaesthesia are suggested due to better precise control of haemodynamics and quicker onset. However, institution of such complex technique may require time which may not be feasible in emergency situations. Use of bilateral ilioinguinal-iliohypogastric nerve block along with low dose spinal anaesthesia may obviate the need of additional epidural catheter in such complicated cases. We hereby present our experience from two cases.
authors.affiliation: Department of Anesthesia and Intensive Care, St. Vincent's University Hospital, Dublin, Ireland. bhaktadr@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Bhakta
authors.affiliation: Department of Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: P K
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Department of Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: R R
authors.initials: RR
authors.lastname: Date
authors.affiliation: Department of anesthesia, Al-Emadi Hospital, Doha, Qatar.
authors.forename: A K
authors.initials: AK
authors.lastname: Mohammad
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000295:instrumentation* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000295:instrumentation / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002585:Cesarean Section; D004359:Drug Therapy, Combination / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D010525:Peripheral Nerves / Q000000981:diagnostic imaging / Q000187:drug effects; D011247:Pregnancy; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine