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Case Studies | Anaesthesiology | India | Volume 12 Issue 3, March 2023 | Popularity: 4.7 / 10

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Bilateral Rectus Sheath Block as an Effective Alternative Anaesthetic Technique for palliative Feeding Jejunostomy in an Advanced Carcinoma Thyroid Patient who Developed Tracheo - Oesophageal Fistula

Dr. K. Haritha, Dr. Shirish Kumar Talakanti

Abstract: Tracheoesophageal fistula (TEF) is an extremely rare complication seen in patients of thyroid cancer who has received chemotherapy and radiation therapy. These patients may present with cough, respiratory distress, difficulty in feeding and pneumonia. Alternative feeding options like feeding gastrostomy/jejunostomy will be planned for such patients as a part of palliative treatment. Administering anaesthesia to such patients is challenging as fistula may cause complications such as aspiration, bleeding, perforation, migration and pneumonia during general anaesthesia. If a concurrent heart condition exists, which increases the risk of central neuraxial block, it is significantly more difficult to administer anaesthesia to such people. Here, we present a case of 62yrs old male patient weighing 60kgs with a BMI of 22kg/m2, ASA class IV, who is a known case of thyroid Carcinoma stage IV with lung metastasis who has developed Tracheoesophageal fistula after chemotherapy and radiation therapy and has posted for feeding jejunostomy as a part of palliative care. We could not adopt even central neuraxial blockade because the pre - anesthesia evaluation also revealed a poor EF of 32% with mid and basal segment and anterior wall hypokinesia in 2D Echo. Due to these significant perioperative concerns, we have opted for ultrasonography - guided bilateral rectus sheath block and patient tolerated the surgery well with minimal sedation. Rectus sheath block is a potentially useful regional anaesthetic technique for abdominal surgeries involving midline incisions, allowing surgery in high - risk patients while avoiding general anaesthesia and central neuraxial blockade, and the real time ultrasonography has increased the success rate with reduced complications of peritoneal puncture, bleeding and visceral injury.

Keywords: Rectus sheath block, Feeding jejunostomy, Tracheo - oesophageal fistula, ASA IV, Ultrasound guided

Edition: Volume 12 Issue 3, March 2023

Pages: 1670 - 1672

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