RESUMO
The bidirectional (BD) Glenn shunt or hemi-Fontan procedure has been used to temporarily improve cardiac function in patients with severe structural heart disease which feature single ventricular physiology. Subsequently, more of these patients present for noncardiac surgical interventions, which present as an anaesthetic challenge. Erector spinae block (ESP) is an effective analgesic modality used in various thoraco abdominal surgeries, which can also be given safely in such patients. A case of a 17-year-old female patient with complex congenital heart disease (CHD) who underwent BD Glenn shunting with main pulmonary artery ligation in childhood, presently admitted for laparoscopic cholecystectomy done under general anaesthesia. With detailed preoperative workups, close haemodynamic monitoring and use of ESP for analgesia during perioperative period, the patient had successful outcome. We outline the anaesthetic management and the concerns of laparoscopy in such patients. A comprehensive understanding of physiology of Glenn's shunt and implications of the proposed surgical procedure is necessary to plan the anaesthetic and analgesic agents, cardiovascular drugs and ventilation strategies in patients with CHD with shunt procedure done.
RESUMO
BACKGROUND AND AIMS: Ultrasound guided transversus abdominis plane block is an efficacious abdominal field block. The aim was to determine the effect of dexamethasone to 0.375% ropivacaine on the analgesic duration of TAP block in patients undergoing lower segment cesarean section (LSCS). METHODS: A single-blinded randomised control study was conducted on 90 patients, who were divided in two groups of 45 each. Group R received 0.375% ropivacaine (25 ml) with normal saline (1 ml) each side and group D received 0.375% ropivacaine (25 ml) with dexamethasone 4 mg (1 ml) each side in transversus abdominis plane block after lower segment cesarean section. Primary objective was to compare time to first rescue analgesia and secondary objectives to compare the total amount of analgesia required in first 24 h postoperatively, visual analog scale scores for somatic and visceral pain and incidence of nausea and vomiting, between the two groups. Student's t test, Chi-square, or Fisher's exact test were performed using SPSS 17.0. RESULTS: Time to first rescue analgesia was significantly less in group R (11.62 ± 3.80 h) compared to group D (19.04 ± 4.13 h) (P < 0.001). Total tramadol consumed in 24 h was significantly higher in group R (86.67 ± 30.55 mg) than group D (35.56 ± 39.54 mg) (P < 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group R than group D at 8 h, 12 h, and 24 h postoperatively. CONCLUSION: Addition of dexamethasone to ropivacaine in transversus abdominis plane block significantly prolongs the duration of postoperative analgesia.