No abstract

Peripheral arterial disease (PAD) patients often require surgical peripheral vascular revascularization (PVR), in which postoperative pain management can be challenging. This case report details a 43-year-old female patient with PAD who underwent urgent femoral popliteal bypass with an inverted ipsilateral great saphenous vein and left femoral endarterectomy. Due to contraindications for neuraxial anesthesia and the necessity for continuous anticoagulation, the procedure was performed under general anesthesia (GA) and an unconventional technique with intraoperative perineural catheter (PC) placement to guarantee adequate postoperative analgesia. The surgeon inserted the PC in the vicinity of the femoral nerve under direct visualization before surgical closure. Postoperative analgesia was successfully managed, demonstrating the effectiveness of this approach as part of a multimodal analgesia strategy. This case report suggests that such a technique, supervised by an anesthesiologist and supported by a multidisciplinary team, can provide effective postoperative pain control in PAD patients without interrupting perioperative anticoagulation. Formal protocols for similar procedures can arise, incorporating this analgesic option.

Aim “COVID has been a great challenge for Hospitals around the world. At our surgical department a new protocol of TAP block was designed and implemented in our laparoscopic incisional ventral hernia repairs, to allow these patients to be operated in ambulatory regime, without compromising pain control and the outcomes. In this video we aim to present the technique for the Laparoscopic-guided TAP Block during a Laparoscopic IPOM Plus ventral hernia repair.” Material and Methods “We implemented this protocol in July 2020 and since then, we performed 18 TAP block in laparoscopic incisional hernia repairs, laparoscopic guided by the Surgeon or ultrasound-guided by the Anesthesiologist. In this case, the video reports to a Laparoscopic IPOM Plus incisional hernia repair performed on a 54-year-old patient, male, with obesity, arterial hypertension and dyslipidemia. He had a 6 centimeter incisional hernia post-colorectal surgery in 2013.” Results “As detailed in the video, we show all the steps to perform a TAP block under laparoscopic direct visualization” Conclusions “TAP block can be performed by the Surgeon, with direct visualization at the beginning of the laparoscopic procedure.”

Aim “COVID has been a great challenge since its beginning. Hospitals had to change/create a lot of clinical pathways and protocols to fight it. As an adaptation to COVID pandemic, our surgical department decided to implement a protocol of Transversus Abdominis Plane Block (TAPB) in laparoscopic incisional ventral hernia repair to allow these patients to be shifted from elective to outpatient regime. This study aimed to analyze the implementation of this protocol during the covid era as a way to have more resources available for COVID patients.” Material and Methods “A retrospective observational study was conducted using data since the beginning of the implementation of the protocol, from July 2020 to May 2021. TAPB was performed in all patients, laparoscopically or ultrasound-guided. Patients and hernia variables were identified using the hospital database. Data was recorded in the recovery room, by a phone call 24h post-surgery and in postoperative consultations with the surgeon.” Results “A total of 18 patients with incisional ventral hernia was included in the study. All patients had laparoscopic incisional ventral hernia repair surgery with TAPB and in ambulatory regime, discharged before 24h, are very satisfied with the protocol in terms of post-operative pain and there are no complications related to the TAPB.” Conclusions “This study found that, despite of COVID Pandemic, implementing a TAP Block procedure during laparoscopic incisional ventral hernia repair, allows to shift these patients from elective to outpatient surgery without compromising the outcomes, pain management and patient security, and, finally, to increase availability of resources for COVID patients.”