Monitored anesthesia care based on ultrasound-guided subcostal transversus abdominis plane block for continuous ambulatory peritoneal dialysis catheter surgery: case series

Abstract

Planning safe perioperative management for patients undergoing continuous ambulatory peritoneal dialysis (CAPD) catheter surgery (insertion and extraction of the catheter) is often difficult because many of these patients not only have renal insufficiency but also have co-existing disorders, such as heart diseases. As increased indications for perioperative anticoagulation therapy have limited the choice of anesthesia, selecting an appropriate anesthetic method, particularly for patients with poor systemic conditions, is becoming more challenging. We report seven cases of CAPD catheter surgery successfully managed by monitored anesthesia care using subcostal transversus abdominis plane (TAP) block with additional local anesthetic infiltration and analgesics. Despite co-existing cardiac disease and/or coagulation disorders, all patients were safely managed without any other major anesthetic methods. Subcostal TAP block is a useful anesthetic option for CAPD catheter surgery, particularly for patients with poor systemic conditions and/or in whom neuraxial blocks are contraindicated.

A Randomized Controlled Trial of Comparing Ultrasound-Guided Transversus Abdominis Plane Block with Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Implantation

“…The switching rate into GA due to intolerable pain was only 5% in the TAP group and was much lower than the LAI group. The previous case series studies reported the switching rate from 0 to 12.5% [21,23,24]. Our study demonstrated that TAP block could lower the switching rate into GA during PDC implantation than LAI, which may decrease the risk during the operation.…”

“…The dosage of ropivacaine used in our study was similar or even lower when compared with that mentioned in the previous studies [20,21,23,24]. The blood level and safety range data of local anesthetic in TAP blocking is still lacking in ESRD patients, which demands to be explored in future studies.…”

“…Previous studies also showed remarkable analgesic effect of TAP block till 24 h after PDC implantation [20,21,23]. …”

“…With the guidance of ultrasound, local anesthetics could be injected into TAP, where the thoracolumbar nerves (T7-L1) pass through to innervate the anterolateral abdominal wall, and result in its analgesic effect [15,16]. Recently, TAP block had been reported as a sole anesthesia technique in abdominal surgery in patients with high risks [17,18,19] and even in PDC implantation [20,21,22,23,24]. …”

Anesthetic management with subcostal transversus abdominis plane block in recessive dystrophic epidermolysis bullosa for peritoneal dialysis catheter replacement: a case report

“…If vascular access cannot be used due to the patient's condition, peritoneal dialysis can be utilized as an alternative [3]. Peritoneal dialysis catheter placement is performed under general or neuraxial or local anesthesia [4]; however, all of these techniques can cause serious complications in patients with RDEB. General anesthesia bears a high risk because airway manipulation can cause mucosal blister formation in the upper airway following critical airway obstruction.…”