#34666 Case report: Ablation of renal tumour in high bmi patient under single shot paravertebral and remifentanil

Abstract

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Background and Aims

Managing patients with multiple comorbidities is an increasingly common requirement of anaesthesiologists. This is compounded by the increasing demand for anaesthesia to be provided outside of the operating theatre. The role of regional anaesthesia and its use in avoiding the general physiological changes associated with general anaesthesia is becoming increasingly apparent.

Methods

Our patient is a 60 year old male presenting for radiofrequency ablation of a renal tumour. His medical history was relevant for tuberculosis involving his lungs and pericardium for which he had undergone a right lower lobectomy and pericardiectomy, and Ulcerative Colitis for which he had undergone a subtotal colectomy. His comorbidities included Chronic Obstructive Pulmonary Disease for which he was on 6 litres/minute of portable oxygen, obstructive sleep apnoea requiring CPAP, recurrent chest infections, Atrial fibrillation on Rivaroxaban, Liver Cirrhosis Childs Pugh A, Grade 1 Obesity, Type 2 diabetes, Gout, steroid induced myopathy.

Results

We report the use of an ultrasound guided paravertebral block in conjunction with monitored sedation using remifentanil to facilitate radiofrequency ablation of a low grade clear cell renal tumour. The procedure was tolerated well with satisfactory ablation of the tumor. Mr. EL was discharged the day after his procedure for follow up imaging in 4 months.

Conclusions

The use of a regional technique allowed us to avoid the complications of general anaesthesia in this high-risk gentleman, while facilitating the ablation of his renal tumor. Paravertebral blocks serve an increasingly important role in facilitating ablation of solid organ tumours, including lung, liver and kidney, in our institution.