title: Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine.
abstract: A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP) block with liposome bupivacaine (Exparel) intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE) was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels.
authors.affiliation: Department of Anesthesiology, Naval Medical Center San Diego.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Terrien
authors.affiliation: Surface Warfare Medical Institute, San Diego.
authors.forename: David
authors.initials: D
authors.lastname: Espinoza
authors.affiliation: Department of Anesthesiology, Robert E. Bush Naval Hospital, Twenty Nine Palms, CA, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Stehman
authors.affiliation: Department of Anesthesiology, Naval Medical Center San Diego.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Rodriguez
authors.affiliation: Department of Anesthesiology, Naval Medical Center San Diego.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Connolly
keywords: liposome bupivacaine (bupivacaine liposome injectable suspension); plasma bupi-vacaine levels; thoracic epidural; transversus abdominis plane (TAP) nerve block