Author : Boyne Bellew
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)
Book Synopsis BILATERAL ERECTOR SPINAE PLANE BLOCKS AS AN ALTERNATIVE TO EPIDURAL IN A PATIENT ON CLOPIDOGREL by : Boyne Bellew
Download or read book BILATERAL ERECTOR SPINAE PLANE BLOCKS AS AN ALTERNATIVE TO EPIDURAL IN A PATIENT ON CLOPIDOGREL written by Boyne Bellew and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and aimsA 63 year old, ASA 4, female patient with a 12 cm abdominal aortic aneurysm due to type II and III endoleaks required a laparotomy via rooftop incision. She was bedbound with significant cardiac, respiratory and renal comorbidities and on clopidogrel for a coronary stent. Bilateral erector spinae plane catheters (ESPC) were used for analgesia in place of epidural to avoid the risk of epidural haematoma.MethodsFollowing general anaesthesia, bilateral ESPC were placed with ultrasound guidance. An initial bolus of 20mls 0.25% levobupivacaine was given bilaterally. Post-operatively, an infusion of plain 0.125% levobupivacaine was commenced at 10mls/hour through each catheter. She required multiple blood products including 28 units of packed red cells.ResultsOn day 2 post-operatively she was able to cough comfortably and was successfully extubated. The ESPC were removed on day 4 post surgery. ConclusionsThe addition of epidurals to general anaesthesia can reduce the 30-day mortality following high-risk surgery and provide excellent analgesia. However, these are contra-indicated in patients requiring some antiplatelet therapies. It is recognised that regional nerve blocks may provide a safer alternative. The ESPC has been shown to be efficacious for abdominal surgery. As this is relatively new, the risk of haemorrhagic complications is not described in current guidelines. We suggest that ESPC may provide a safer alternative to epidurals in patients on clopidogrel.