Luis-Navarro Juan Carlos, Fornés-Rumbao Carmen, DeLaCalle-Gil Ana Bella, Forero Mauricio
Anesthesia-Reanimation Service, Virgen Del Rocio University Hospital, Seville, Spain.
Anesthesia Department, McMaster University, Hamilton, Canada.
Case Rep Anesthesiol. 2020 Mar 27;2020:6062935. doi: 10.1155/2020/6062935. eCollection 2020.
Multimodal anesthesia, which combines general and epidural anesthesia, is used in surgical cases in which a large or painful incision is anticipated. However, both epidural blocks and opioid-based analgesia have limitations in application. Here, we present a case of supra-infraumbilical laparotomy in a patient whose history of neurostimulator use and marked scoliosis discouraged the placement of an epidural catheter and whose prior adverse response to opioids prohibited their use. The intraoperative and postoperative management of this patient consisted of a combination of analgesia without opioids and erector spinae plane block. Adequate analgesia was achieved, and intraoperative or postoperative opioids were not required. This case illustrates the importance of mastering alternative and multimodal analgesia techniques that can be used in place of classical analgesia techniques when classical analgesia techniques are not appropriate.
多模式麻醉结合了全身麻醉和硬膜外麻醉，用于预计有大切口或疼痛切口的手术病例。然而，硬膜外阻滞和基于阿片类药物的镇痛在应用中都有局限性。在此，我们报告一例脐上剖腹手术病例，该患者有使用神经刺激器的病史且有明显脊柱侧弯，这使得硬膜外导管置入受阻，并且其既往对阿片类药物的不良反应禁止使用阿片类药物。该患者的术中和术后管理包括非阿片类镇痛和竖脊肌平面阻滞相结合。实现了充分镇痛，术中或术后无需使用阿片类药物。该病例说明了掌握替代和多模式镇痛技术的重要性，当经典镇痛技术不适用时，这些技术可用于替代经典镇痛技术。
