Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case

Detalhes bibliográficos
Autor(a) principal: Almeida,Carlos
Data de Publicação: 2018
Outros Autores: Assunção,José Pedro
Tipo de documento: Relatório
Idioma: eng
Título da fonte: Revista Brasileira de Anestesiologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000600657
Resumo: Abstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.
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spelling Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery caseQuadratus lumborum blockOpen aortic surgeryHypotensionAbstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.Sociedade Brasileira de Anestesiologia2018-11-01info:eu-repo/semantics/reportinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000600657Revista Brasileira de Anestesiologia v.68 n.6 2018reponame:Revista Brasileira de Anestesiologia (Online)instname:Sociedade Brasileira de Anestesiologia (SBA)instacron:SBA10.1016/j.bjane.2018.05.002info:eu-repo/semantics/openAccessAlmeida,CarlosAssunção,José Pedroeng2018-11-22T00:00:00Zoai:scielo:S0034-70942018000600657Revistahttps://www.sbahq.org/revista/https://old.scielo.br/oai/scielo-oai.php||sba2000@openlink.com.br1806-907X0034-7094opendoar:2018-11-22T00:00Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)false
dc.title.none.fl_str_mv Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
title Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
spellingShingle Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
Almeida,Carlos
Quadratus lumborum block
Open aortic surgery
Hypotension
title_short Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
title_full Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
title_fullStr Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
title_full_unstemmed Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
title_sort Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case
author Almeida,Carlos
author_facet Almeida,Carlos
Assunção,José Pedro
author_role author
author2 Assunção,José Pedro
author2_role author
dc.contributor.author.fl_str_mv Almeida,Carlos
Assunção,José Pedro
dc.subject.por.fl_str_mv Quadratus lumborum block
Open aortic surgery
Hypotension
topic Quadratus lumborum block
Open aortic surgery
Hypotension
description Abstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.
publishDate 2018
dc.date.none.fl_str_mv 2018-11-01
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dc.relation.none.fl_str_mv 10.1016/j.bjane.2018.05.002
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
dc.source.none.fl_str_mv Revista Brasileira de Anestesiologia v.68 n.6 2018
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