Abstract

Emphasis on opioid sparing multimodal analgesia and anesthesia has encouraged practitioners to become adept in the placement and use of complex regional blocks. Studies indicate that transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) provide adequate and prolonged analgesia after invasive abdominal and pelvic procedures. A laparoscopic-assisted right hemicolectomy and sigmoid colon resection performed on a 70-year old female was managed using general anesthesia, isoflurane, intravenous (IV) rocuronium, and IV fentanyl. An ultrasound guided TAPB was performed through a posterior approach following the closure of the incision. A total of 20 ml of plain bupivacaine 0.25 % was administered on each side of the abdomen to provide full analgesic coverage of the anterior abdominal wall. The procedure concluded with a total of 150 mcg of fentanyl IV. Twenty-four hours post-surgery, the patient had received a total IV medications of fentanyl 100 mcg, ketorolac 90 mg, acetaminophen 2 grams, hydromorphone 1.5 mg, and meperidine 50 mg. Patient-controlled analgesia was not required for pain management as is often needed after this type of surgery. Postoperative day (POD) three showed fentanyl 50 mcg IV and meperidine 100 mg IV. The fourth POD record reported a total IV dose of fentanyl 50 mcg and meperidine 50 mg. The patient was discharged home on POD five on oral tramadol hydrochloride.

Author Details

McGowan, Aleen Joy, DNP (c)

Sigma Membership

Unknown

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Literature Review

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Nerve Block, Postoperative Analgesia, Colorectal Surgery

Advisor

Ledbetter, Maria

Second Advisor

Rankin, Heather

Degree

DNP

Degree Grantor

Samford University

Degree Year

2021

Rights Holder

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All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2021-03-24

Full Text of Presentation

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