Gastrostomy Under Paravertebral Block in High-Risk Patients with Esophageal Cancer – Two Case Reports

Abstract

Here we present two cases of gastrostomy insertion via laparotomy in patients with malignant esophageal disease. Patients were ASA (American Society of Anesthesiologists) physical status III and IV. The patients presented as very high risk for general anesthesia, so we decided to use unilateral left sided paravertebral block (PVB) on four thoracic levels along with contralateral local infiltration at the gastrostomy insertion site. We present two cases, one of them a 57-year-old male ASA III patient scheduled for a gastrostomy procedure due to esophageal cancer with infiltration of the trachea. We also present a case of a 59-year-old male patient, ASA IV status, scheduled for the same procedure due to advanced esophageal cancer with a fistula between the left main bronchus and the esophagus and metastases in the left lung. The paravertebral space was identified with the use of an 8 Hertz (Hz) linear ultrasound probe and a nerve stimulator. Paravertebral block was successfully used for insertion of a gastrostomy, thereby enabling adequate anesthesia and perioperative analgesia without hemodynamic or respiratory complications.

Technical Difficulties and Procedural Complications in Closing Malignant Esophageal-Respiratory Fistulas

“…The only surgical alternatives, i.e. esophagostomy or gastrostomy, come with a quality of life that is unacceptable and while allowing enteral nutrition, do not ensure adequate prevention of fluid aspiration in the respiratory tract ( 13 - 15 ).…”