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Case Studies | Anaesthesiology | India | Volume 13 Issue 5, May 2024 | Rating: 4.9 / 10
Bilateral TAP Block (Transversus Abdominus Plane Block) in a Case of Dilated Cardiomyopathy with Left Ventricular Clot for Cystolithotomy: A Case Report
Nilesh Powar | Manali Nadkarni | Shraddha Devarukhkar | Attamsingh Heero
Abstract: Dilated cardiomyopathy a myocardial disease characterised by impairment of ventricular contractility and dilatation of the left or biventricular ventricles. Due to poor left systolic function, ventricular enlargement, the risk of malignant arrhythmias, and sudden cardiac death, anaesthesiologists face a difficulty while managing patients with dilated cardiomyopathy (DCM) during anaesthesia. Case discussion: 50 years male a case of dilated cardiomyopathy, cardiac failure diagnosed a week back, was treated with diuretics and on ventilatory support. He was planned for AICD. During investigation bladder calculi with microscopic hematuria was noted. Patient was posted for cystolithotomy. Investigation showed mild anaemia with leucocytosis. Under all aseptic precautions, USG guided Bilateral transversus abdominus plane (TAP) block given. TAP block was performed with modification where in the probe was placed 2 cm anterior to iliac crest with 15cc of 0.75% ropivacaine and 15cc of 0.5% bupivacaine were diluted with normal saline to deposit 30 ml of volume on either side. Patient was sedated with injection Fentanyl (50mcg) and dexmedetomidine infusion was adjusted to 0.5mcg/kg/minute dose. Conclusion: The management of patients, pre optimization, planning multidisciplinary approach is key to success. Real time use of USG is safe for regional anaesthesia with dexmedetomidine can lead to favourable outcome.
Keywords: Dilated cardiomyopathy, TAP block, hemodynamic stability, anaesthesia management, multidisciplinary approach
Edition: Volume 13 Issue 5, May 2024,
Pages: 1401 - 1403