Percutaneous gastrostomy tube placement under regional anaesthesia in Riga 1st hospital

The influence of the mode of anaesthesia on outcome of polymorbid patients is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. If general anaesthesia can lead to death of the patient, regional anaesthesia might be chosen as an alternative.  The case report of 59 years old woman who was admitted to Riga’s 1st hospital for percutaneous gastrostomy tube (PGT) placement due to hypopharynx carcinoma, malnutrition and difficulty with swallowing solid food nor liquid. The need for PGT placement in operating room was established due to failure to perform percutaneous endoscopic gastrostomy. The serious problem was patient’s airway obstruction due to the hypopharynx carcinoma, followed by desaturation under 1.2mg/kg intravenous propofol sedation. The anaesthesia of choice was quadratus lumborum block type 2 (QLB2). The left side QLB2 was performed under ultrasonographic control with curvilinear probe with 100 millimetre plexus needle. The anaesthetics of choice were ropivacaine 7,5 milligrams (mg) and lidocaine 100 mg. Total volume of 20 millilitres were injected. Intraoperatively the patient received the total of 200 mcg of fentanyl by fractions of 50 mcg and ketamine total dose of 50 mg. No local infiltration of skin or other tissues was performed by the surgeon. The length of the surgery was 10 minutes. Intraoperatively the patient reported sensation of pain in numeric rating scale (NRS) from 1 to 10. Postoperatively the patient received multimodal analgesia with acetaminophen, metamizole and NSAIDs. Reported immediate (0–2 hours) postoperative pain was NRS 4, after 6 hours – NRS 3, after 16 hours – NRS 2-3. Quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following percutaneous gastrostomy.