Hayaran Nitin, Malhotra Rohit, Tyagi Swati, Jain Aruna
From the Departments of Anaesthesia.
Obstetrics and Gynaecology.
A A Pract. 2019 Mar 15;12(6):185-186. doi: 10.1213/XAA.0000000000000875.
Acute fatty liver of pregnancy is one of the most common causes of fulminant hepatic failure. A 28-year-old G3P1L1A1 presented at 37 weeks with diagnosis of acute fatty liver of pregnancy with grade 3 hepatic encephalopathy. Laboratory findings were suggestive of coagulopathy, metabolic acidosis, and liver and renal dysfunction. Ultrasound-guided transversus abdominis plane block with ilioinguinal-iliohypogastric nerve block is widely used for postoperative analgesia. We applied these blocks, supplemented with intravenous ketamine for breakthrough visceral pain, to conduct cesarean delivery with a favorable outcome. Thus, transversus abdominis plane with ilioinguinal-iliohypogastric is a viable alternative in patients where general and neuraxial anesthesia is unsafe.
妊娠急性脂肪肝是暴发性肝衰竭最常见的病因之一。一名28岁、孕3产1、有1次活产史、1次流产史的孕妇在孕37周时就诊，诊断为妊娠急性脂肪肝伴3级肝性脑病。实验室检查结果提示存在凝血病、代谢性酸中毒以及肝肾功能不全。超声引导下腹横肌平面阻滞联合髂腹股沟-髂腹下神经阻滞广泛用于术后镇痛。我们应用这些阻滞方法，并辅以静脉注射氯胺酮以缓解突破性内脏痛，成功实施了剖宫产手术，效果良好。因此，对于全身麻醉和椎管内麻醉不安全的患者，腹横肌平面阻滞联合髂腹股沟-髂腹下神经阻滞是一种可行的替代方法。
