Pullano Carmine, Marrone Francesco, Paventi Saverio, Forasassi Lorenzo, Starnari Roberto
Anesthesia, Villa Pia Clinic, Rome, ITA.
Anesthesiology and Critical Care, Santo Spirito Hospital, Rome, ITA.
Cureus. 2024 Jan 22;16(1):e52711. doi: 10.7759/cureus.52711. eCollection 2024 Jan.
Laparoscopy has become a milestone with reduced surgical stress and postoperative pain. Evidence promotes erector spinae block for laparoscopic abdominal surgery, in particular for cholecystectomy. The thoracic paravertebral space block is the administration of local anesthetic into a wedge-shaped space on the antero-lateral thoracic spine and provides abdominal analgesia. We hypothesized that a combination of two paravertebral by proxy blocks (erector spinae and intertransverse process (ITP)) with multi-dermatomeric coverage and visceral pain control, with evidence for intra- and postoperative analgesia in thoracic and abdominal surgeries, may be a surgical anesthesia option for laparoscopy. A 42-year-old patient with gastroesophageal reflux disease (GERD) was scheduled for a laparoscopic Nissen fundoplication. He was 173 cm in height and weighed 90 kg (BMI 30 kg.m) and was classified in the American Society of Anesthesiologists Physical Status Classification System (ASA-PS) as 2. He had a history of difficult airway and refused general anesthesia. With the patient's informed written consent, we performed a bilateral thoracic erector spinae plane (T-ESP)/ITP blocks at the T4-8 level. Surgery was performed with the patient spontaneously breathing under sedation without complications. Hence, the combination of ESP-ITP blocks was a good anesthesia option for the planned surgery without side effects and optimal postoperative pain control.
腹腔镜检查已成为减少手术应激和术后疼痛的一个里程碑。有证据支持在腹腔镜腹部手术中，尤其是胆囊切除术中采用竖脊肌阻滞。胸椎旁间隙阻滞是将局部麻醉药注入胸椎前外侧的楔形间隙，可提供腹部镇痛。我们推测，一种通过替代阻滞（竖脊肌和横突间（ITP））联合的方法，具有多节段皮肤覆盖和内脏痛控制，且有证据表明其在胸腹部手术中具有术中及术后镇痛效果，可能是腹腔镜手术的一种麻醉选择。一名42岁的胃食管反流病（GERD）患者计划接受腹腔镜下Nissen胃底折叠术。他身高173厘米，体重90千克（BMI 30 kg·m²），美国麻醉医师协会身体状况分类系统（ASA-PS）分级为2级。他有困难气道病史，拒绝全身麻醉。在患者书面知情同意下，我们在T4-8水平进行了双侧胸椎竖脊肌平面（T-ESP）/ITP阻滞。手术在患者镇静下自主呼吸状态下进行，无并发症发生。因此，ESP-ITP阻滞联合是计划手术的一种良好麻醉选择，无副作用且术后疼痛控制良好。
