Key result
Subcostal transversus abdominis plane block provides sufficient analgesia for defunctioning ileostomy in a frail patient.
Why the study?
A subcostal transversus abdominis plane block was considered as an alternative analgesic technique for a high-risk frail elderly patient with contraindications to thoracic epidural and limited physiological reserve undergoing defunctioning ileostomy.
Population
1 frail elderly patient with small bowel obstruction and atrial fibrillation with pre-operative INR > 10
Comparison
Subcostal transversus abdominis plane block with low-dose remifentanil infusion vs local anaesthesia and sedation alone
Design
Case report
Authors
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May offer alternative when GA or epidural contraindicated in frail patients; hypothesis-generating, needs prospective validation before practice change.
Case Report (n=1)
A subcostal transversus abdominis plane block can provide effective analgesia for abdominal surgery in high-risk patients where general anesthesia or epidural placement is contraindicated.
O’Connor et al. (2009) conducted a case report in Small bowel obstruction requiring defunctioning ileostomy (n=1). Subcostal transversus abdominis plane block was evaluated on Analgesia during surgery. A subcostal transversus abdominis plane block using 20 ml 0.5% levobupivicaine provided sufficient analgesia for a defunctioning ileostomy in a frail elderly patient.
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