383 posters, 2 videos, 1 audios, 8 topics, 28 sessions, 328 authors, 225 institutions
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50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
May 1 - 3, 2025 | Orlando, Florida
6430
REGIONAL ANESTHESIA IN PATIENT WITH CIRRHOSIS UNDERGOING UPPER EXTREMITY ORTHOPEDIC SURGERY: A CASE REPORT.
Part of Topic
Medically Challenging Cases
Regional Anesthesia in Patient with Cirrhosis Undergoing Upper Extremity Orthopedic Surgery: A Case Report.
Introduction
•Anesthetizing patients with liver disease poses challenges
•Regional anesthesia can minimize the use of drugs with more systemic effects
•Coagulopathy in this patient population can be a concern for regional anesthesia
Methods
•As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per Mayo Clinic policy 45 CFR 46.102. Patient consent was obtained for this case report’s use and publishing.
Case
72-year-old man with right elbow olecranon bursitis presented for olecranon bursa excision.
• ASA IV, BMI 37, HTN, pHTN; OSA, CKD stage 3b. T2DM
•Compensated alcoholic cirrhosis complicated by portal HTN, esophageal varies, gastric antral vascular ectasia and thrombocytopenia
•History of delayed emergence under general anesthesia
•MELD-Na and MELD 3.0 scores of 15
•TTE with estimated RVSP 32 mmHg, concentric LV remodeling, LVEF 64%
Perioperative management and course:
•Axillary block with 30 mL of bupivacaine 0.5% with 1:200,000 epi
•MAC with 35 mcg/kg/min propofol infusion
•Dexmedetomidine(20 mcg total) and IV remimazolam (10 mg total)
•Additional 100 mg ropivacaine around the bursa by the surgeon.
•Hemodynamic support maintained with phenylephrine and glycopyrrolate pushes
Postoperative course:
•Pain score was 0/10 with appropriate sensory and motor blockade
•No additional pain medications
•Discharged home