Combined intercostal nerve block and epidural anesthesia in a patient with severe aortitis syndrome
Ohkado, S.; Nishiyama, T.; Tamai, H.; Yajima, C.; Hanaoka, K.
Masui. Japanese Journal of Anesthesiology 49(7): 782-784
2000
ISSN/ISBN: 0021-4892 PMID: 10933035 Document Number: 523341
A 74-year-old woman with aortitis syndrome was scheduled for mastectomy. Her left vertebral artery was totally occluded and left carotid arteries, left subclavia artery and bilateral common renal arteries were occluded. For anesthesia a catheter was inserted into the epidural space between T 3 and T 4. Lidocaine 80 mg (2%, 4 ml) was administered epidurally. Then intercostal nerve block was performed with bupivacaine 15 mg (0.5%, 3 ml) at T 3 and T 4 level. Local infiltration of lidocaine 50 mg (1%, 5 ml) was added. During the surgery, hemodynamics were stable and no neurological symptom was observed. Epidural anesthesia alone might be sufficient for anesthesia if higher concentration of local anesthetic was used. However, to avoid hemodynamic change, we were 1% lidocaine and added intercostal nerve block. We conclude that combined intercostal nerve block and epidural anesthesia was useful for a patient with severe aortitis syndrome in oder to monitor consciousness to detect cerebral ischemia and to avoid hemodynamic instability.