Combination of Rectus Sheath Block and Subcostal Transversus Abdominis Plane Block as the Sole Anesthesia for an Open Gastrostomy in a High-risk Patient

Abstract

Truncal blocks are widely used for postoperative analgesia, but are rarely used for surgical anesthesia. Herein is reported the success of an open gastrotomy under truncal blocks in a patient for whom general anesthesia and neuraxial blockade were undesirable. A 79-year-old man, with advanced esophageal cancer presented with several comorbidities; including cardiomyopathy, ischemic heart disease, and prior cerebral infarction. Difficulty in airway management was anticipated due to the mass’s compression on the airway. Anesthesia was achieved using a combination of truncal blocks; this being the rectus sheath block and the subcostal transversus abdominis plane block, supplemented by intravenous fentanyl for managing visceral pain.