title: Multimodal analgesia in abdominal sepsis: a case report of liposome bupivacaine in ultrasound-guided rectus sheath blocks after unexpected open hemi-colectomy.
abstract: OBJECTIVE
  Contrasted with open laparotomy, the risk-benefit ratio of epidural anesthesia in laparoscopic surgery frequently disfavors its use. The presence of abdominal sepsis also affects utilization with concerns about the risks of epidural abscess and hypotension. In the unplanned conversion to open laparotomy, postoperative pain control becomes more difficult. We discuss utilization of rectus sheath blocks with liposome bupivacaine as a component of multimodal analgesia in a patient with abdominal sepsis from a perforated appendix.
  
  
  METHODS
  A 33-year-old healthy male Soldier presented with a perforated appendix. Treatment consisted of urgent laparoscopic appendectomy that was subsequently converted to an open right hemicolectomy. Bilateral rectus sheath blocks were performed with liposome bupivacaine before awakening to mitigate postoperative pain. The patient reported mild postoperative pain scores, was able to ambulate comfortably on the day of surgery, and had early return of bowel function.
  
  
  CONCLUSIONS
  This case describes rectus sheath blocks with liposomal bupivacaine for postoperative pain control and to hasten functional recovery following an unplanned conversion to open hemicolectomy. This application provided many of the benefits of epidural analgesia while avoiding some of its most serious risks, making it a valuable analgesic option for the patient with abdominal sepsis.
authors.affiliation: Department of Anesthesia and Operative Services, San Antonio Military Medical Center, 3551 Roger Brooke Drive Number 3600, San Antonio, TX 78219.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Patzkowski
authors.affiliation: Department of Anesthesia and Operative Services, San Antonio Military Medical Center, 3551 Roger Brooke Drive Number 3600, San Antonio, TX 78219.
authors.forename: Gregory
authors.initials: G
authors.lastname: Stevens
mesh_terms: D000009:Abdominal Muscles; D061605:Administration, Intravenous; D000328:Adult; D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000601:surgery; D002045:Bupivacaine / Q000008:administration & dosage*; D003082:Colectomy / Q000009:adverse effects; D061887:Conversion to Open Surgery / Q000009:adverse effects; D006801:Humans; D008081:Liposomes; D008297:Male; D008889:Military Personnel; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D018084:Ultrasonography, Interventional; D014481:United States
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine