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Evaluation and management of subglottic stenosis in pregnancy is challenging. It often is not only a multidisciplinary approach between obstetricians, otolaryngologists (ENT surgeons) and anesthesiologists, but also requires a thorough understanding of possible foreseen complications by the patient as well. Hence, whenever we are presented with a challenging case requiring multidisciplinary approach involving team of physicians from different specialties, it is routine practice to huddle regarding the preoperative, intraoperative and postoperative management and care. We present a case of a 37-year-old woman with a known history of idiopathic subglottic stenosis, 16 weeks’ pregnant, G4P1, with a surgical history significant for two previous subglottic dilations in the past and who now presented with an audible stridor and shortness of breath on activity. We highlighted the unique challenges encountered and the corresponding management adopted. This is a case of successful management of symptomatic worsening of subglottic stenosis managed during pregnancy.

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With the implementation of enhanced recovery pathways (ERAS) in kidney surgeries, regional techniques are being considered an important aspect of multimodal analgesia. Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries, however their efficacy in kidney surgery remains unknown. To our best knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy. Study Objectives: Assess analgesic efficacy between QLB and post-operative opioid consumption in robotic laparoscopic nephrectomy. Design and Setting: A retrospective chart review was conducted by querying the electronic medical record system of 2,200 bed tertiary academic hospital center in New York City. Outcomes: The primary measured outcome was postoperative morphine milli equivalent (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME, as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours post-operatively. Results: The mean total post-operative MME in the pQLB group was 11 [4, 18] and 15 [5.6, 28] in the control group (p =.001). There was a significant reduction in intra-operative MME in the QLB group in comparison to the control group. This reduction was not seen in post-operative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours post-operatively. Conclusion: Our study provides compelling support that ultrasound guided QLB significantly decreased intra operative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an ERAS pathway. Keywords: Kidney surgeries, Robotic laparoscopic nephrectomy, quadratus lumborum block (QLB), enhanced recovery pathways (ERAS)