Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.009
Brazilian Journal of Anesthesiology
Case Report

Abdominal wall blocks for emergency ileostomy operation in a patient with COVID-19 pneumonia: a case report

Bloqueios de parede abdominal para ileostomia operatória de emergência em paciente com pneumonia COVID-19: relato de caso

Bulent Baris Guven; Tuna Erturk; Temel Güner; Ayşın Ersoy

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Abstract

The anesthesia method to be administered during emergency surgical procedures for COVID-19 (Coronavirus Disease 2019) pneumonia patients carries great importance for both patient and surgical team. Regional blocks are generally used to ensure postoperative analgesia after abdominal surgery with general anesthesia. In this case, involving a patient receiving anticoagulant treatment due to COVID-19 pneumonia with planned emergency operation, the aim was to present the anesthesia management with rectus sheath and transversus abdominis plane block combination for the ileostomy operation. Due to the administered blocks, the patient was not given general anesthesia. Hence, transmission was reduced by minimizing aerosol formation in terms of protecting health personnel and worsening of the patient’s pneumonia was prevented. The case is discussed in terms of regional anesthesia techniques offering a good alternative in appropriate cases for both employee and patient safety in the present day, when the whole world is affected by the COVID-19 pandemic.

Keywords

COVID-19;  Pneumonia;  Ileostomy;  Anesthesia

Resumo

O método de anestesia a ser administrado durante procedimentos cirúrgicos de emergência para pacientes com pneumonia COVID-19 (Coronavirus Disease 2019) é de grande importância tanto para o paciente quanto para a equipe cirúrgica. Os bloqueios regionais são geralmente usados para garantir analgesia pós-operatória após cirurgia abdominal com anestesia geral. Neste caso, envolvendo um paciente em tratamento anticoagulante devido a pneumonia COVID-19 com operação de emergência planejada, o objetivo foi apresentar o manejo da anestesia com combinação de bainha do reto e bloqueio do plano transverso do abdome para a operação de ileostomia. Devido aos bloqueios administrados, o paciente não recebeu anestesia geral. Portanto, a transmissão foi reduzida minimizando a formação de aerossol em termos de proteção do pessoal de saúde e o agravamento da pneumonia do paciente foi evitado. O caso é discutido em termos de técnicas de anestesia regional que oferecem uma boa alternativa em casos apropriados para a segurança do funcionário e do paciente nos dias atuais, quando o mundo inteiro é afetado pela pandemia de COVID-19.

Palavras-chave

COVID-19; Pneumonia; Ileostomia; Anestesia

References

1 K. Tran, K. Cimon, M. Severn, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review PLoS One, 7 (2012), Article e35797

2 Tt Horlocker, E. Vandermeuelen, Sl Kopp, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (fourth edition) Reg Anesth Pain Med, 43 (2018), pp. 263-309

3 J. Zhu, X. Wang, J. Gong, et al. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial BMC Anesthesiol, 20 (2020), p. 22

4 D.Q. Tran, D. Bravo, P. Leurcharusmee, et al. Transversus abdominis plane block: a narrative review Anesthesiology, 131 (2019), pp. 1166-1190

5 O. Ng, S.Y. Thong, C.S. Chia, et al. Revision of loop colostomy under regional anaesthesia and sedation Singapore Med J, 56 (2015), pp. e89-e91
 

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