ESRA19-0283 Saved by continuous spinal anesthesia: from an inguinal hernioplasty to a partial cystectomy – a case report

Background and aims Continuous spinal block (CSB) combines the fast onset of spinal block with the possibility of repeated administration of titrated doses (with lower risk of cardiovascular and respiratory disturbances) along with the possibility to prolong anesthesia in long surgeries.1 2 Methods A 66-year-old male, ASA III, with a history of insulin-dependent diabetes mellitus, chronic renal disease under hemodialysis, obesity, ischemic heart disease, atrial fibrillation and obstructive sleep apnea syndrome was proposed for an urgent right inguinal hernioplasty with suspected partial bladder involvement. After standard ASA monitoring an ultrasound-guided unilateral TAP block with 20 ml of 0.5% ropivacaine was perform under mild sedation. For anesthesia, a subarachnoid catheter was placed at L3-L4 level. A mixture of levobupivacaine 5 mg and sufentanil 2ug was administered. Surgery lasted 3 hours and the initial lateral incision was converted to a medial one to perform a partial cystectomy. To ensure an adequate anesthesia additional 3 and 4 mg of levobupivacaine were administered. Results The patient remained hemodynamically stable throughout the procedure. The spinal catheter was removed at the end of the surgery. The postoperative course was uneventful and postoperative pain was controlled. Conclusions Given the patient’s comorbidities and the uncertainty of the type and duration of surgery, CSB seemed the best option because it allowed an excellent titration of local anesthetic along with excellent surgery conditions. Regional techniques can be useful to manage high risk patients, particularly in the context of urgent surgeries where there is no time for adequate preoperative study and optimization.