Aikawa Katsuhiro, Tanaka Nobuhiro, Morimoto Yuji
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
JA Clin Rep. 2018 May 8;4(1):37. doi: 10.1186/s40981-018-0175-0.
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare, hereditary mucocutaneous disorder that can involve renal insufficiency. If a vascular access for hemodialysis is unavailable, peritoneal dialysis can be utilized. This report describes an anesthetic management with ultrasound-guided transversus abdominis plane block (TAPB) in a patient with RDEB for peritoneal dialysis catheter replacement.
A 49-year-old woman with RDEB needed to undergo peritoneal dialysis catheter replacement. As general, neuraxial and local infiltration anesthesia can lead to serious complications; we planned anesthetic management with subcostal TAPB as the primary analgesia modality. In the operating theater, surgery was initiated after performing left-sided subcostal TAPB. The patient complained of moderate pain at some points during surgery, and the pain was controlled with intravenous or local anesthetics without serious complications.
In summary, subcostal TAPB could be a useful option for peritoneal dialysis catheter surgery in patients with RDEB.
隐性遗传性营养不良型大疱性表皮松解症（RDEB）是一种罕见的遗传性皮肤黏膜疾病，可累及肾功能不全。若无法建立血液透析的血管通路，可采用腹膜透析。本报告描述了在一名RDEB患者进行腹膜透析导管置换时，采用超声引导下腹横肌平面阻滞（TAPB）的麻醉管理。
一名49岁的RDEB女性患者需要进行腹膜透析导管置换。由于全身麻醉、椎管内麻醉和局部浸润麻醉可能导致严重并发症，我们计划以肋下TAPB作为主要镇痛方式进行麻醉管理。在手术室，实施左侧肋下TAPB后开始手术。患者在手术过程中的某些时刻主诉中度疼痛，通过静脉或局部麻醉药控制了疼痛，未出现严重并发症。
总之，肋下TAPB对于RDEB患者的腹膜透析导管手术可能是一种有用的选择。
