[Successful anesthetic management of tracheal reconstruction and omentopexy with thoracic epidural anesthesia and transversus abdominis plane block].

A 64-year-old man was diagnosed to have a tracheal tumor 2 cm proximal to the carina. He was scheduled for tracheal resection and reconstruction with omentopexy. An epidual tube was placed at the level of T5-6. After induction of anesthesia by propofol and remifentanil, a tracheal tube was inserted with the aid of bronchofiberscopy. Bilateral transversus abdominis plane block (TAPB) was performed with 0.5% ropivacaine 40 ml under ultrasound guidance. Anesthesia was maintained by sevoflurane and remifentanil, together with epidural infusion of ropivacaine and fentanyl. During tracheal resection and reconstruction, his left main bronchus was intubated directly from the cutting edge. After the operation, he was extubated under anesthesia without coughing. No pain was complained during postoperative course. Epidural anesthesia combined with TAPB provided sufficient postoperative analgesia, especially in tracheal resection and reconstruction with omentopexy.