类癌综合征:利用竖脊肌平面阻滞的创新麻醉方法

Ojaswani Rai Sood, Mohmad Salim
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摘要

一名 57 岁的女性因乳腺癌接受了右侧乳房切除术和植入物手术,她既有类癌综合征病史,又有广泛的肝转移。术前优化措施包括输注奥曲肽和抗焦虑药,以及计划进行心脏稳定麻醉,以避免任何危机应激因素。在异丙酚镇静的情况下,使用0.2%罗哌卡因在超声引导下进行胸廓(T4)ESP阻滞,然后使用瑞芬太尼和异丙酚麻醉。术中使用奥曲肽输注和栓剂治疗低血压和心动过缓。围术期奥曲肽给药、术中瑞芬太尼和异丙酚麻醉以及ESP阻滞的组合提供了令人满意的麻醉效果。阻滞在术后 36 小时内有效,患者在入院 48 小时后出院。我们认为,在类癌综合征患者的治疗中,ESP阻滞这种新型筋膜间平面阻滞是麻醉师的有效补充,其目的是减少患者对吗啡的依赖,并防止患者转为慢性疼痛。
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Carcinoid syndrome: Innovative anesthetic approach utilizing erector spinae plane block
A 57-year-old female with history of carcinoid syndrome along with extensive liver metastases presented for a right sided mastectomy and implant insertion for breast cancer. Preoperative optimization included an octreotide infusion and anxiolysis, as well as planning a cardiostable anaesthetic that avoided any crisis stressors. Ultrasound guided thoracic (T4) ESP block using 0.2% Ropivacaine was given under propofol sedation followed by remifentanil and propofol anaesthesia. Octreotide infusion along with boluses was used to treat hypotension and bradycardia intraoperatively. The combination of perioperative octreotide administration, intraoperative remifentanil and propofol anaesthesia and ESP block provided satisfactory anaesthesia. The block was effective for 36 hours post-operatively and the patient was discharged 48 hours post admission. We suggest that a novel interfascial plane block, ESP block is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome with an aim to decrease dependence on morphine and preventing conversion to chronic pain.
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