Liver trauma secondary to ultrasound-guided transversus abdominis plane block

Abstract

The effect of the first EBP waned and a second EBP was performed about 42 days later. A larger blood volume (35 ml) was injected, and the patient was maintained in a head-down position for 20 min. Within a couple of hours, he became more alert and there was marked improvement in his social behaviour. This improvement was not as marked as that following the first EBP and lasted for ,1 month. A repeat MRI of the brain did not show any CSF leak. At the request of the neurologist and the family, a third and final EBP was performed about 5 months later. Twenty millilitres of blood were injected into the epidural space. This resulted in improvement of symptoms, both social and cognitive, albeit short-lived. HHB is responsible for the most severe form of apathy. Diagnosis is mainly clinical. The most characteristic features on MRI are brainstem swelling and sagging of the brain in the absence of meningeal enhancement. 2 EBP resolves symptoms in patients with HHB 2 by elevating the epidural and CSF pressures. The most likely mechanism causing symptoms in HHB is spontaneous intracranial hypotension secondary to CSF leak. 3 After consideration of the limited literature with regard to treatment of the condition and the potential benefits of an EBP, we decided to proceed. It was unfortunate that no CSF leak was identified, as it could then have been amenable to radiological or surgical intervention for sustained relief of symptoms. We performed the EBP in the lumbar inter-space, as it is technically easier, safer, and can accommodate a larger volume of blood. The patient required a repeat EBP after a month in view of the non-sustained effect of the previous blood patch. No complications, attributed to the epidural, were seen in our patient during the follow-up.

Ultrasound-guided truncal blocks for perioperative analgesia

“…Following the more widespread application of ultrasound for assisting nerve block techniques, the TAP block has been Potential complications include organ damage and local systemic toxicity due to the relatively large injection volume used in this procedure [52,53].…”

Effect of Transverse Abdominis Plane Block on Chronic Post-Operative Pain—A Review

“…Since the development of ultrasound guided technique no organ injuries have been reported while the procedure [42] except one case of liver injury which was said due to the result of excessive depth of penetration due to failure to accurately image the entire needle during the procedure [43]. Farooq et al [44] also reported a case of liver injury while using the Landmark based technique.…”

Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

“…49 Other technical variants include a 'multiple injection' Figure 6 Mean length of hospital stay technique and continuous infusion via a subcutaneous catheter. [50][51][52] The landmark technique, albeit running a marginally higher risk of significant visceral injury, 53,54 blocks the T7 and T8 dermatomes more reliably than ultrasonography guided blocks, 22,49 perhaps reflecting sites of injection. 55 Posteromedial spread outside the TAP has also been hypothesised to possibly affect visceral afferents, a property that might prove particularly useful in colorectal surgery.…”