Anesthesia for major abdominal surgery in patients in poor physical condition. The combination of surface anesthesia with bilateral intercostal nerve block

Abstract

An anesthetic technique for major abdominal surgery is described, which consists of liqht general anesthesia, combined with bilateral intercostal nerveblock from T6 to T11 blocks are performed just behind the midaxillary line on the unconscious patient. This technique proved to be particulary valuable for patients in very poor conditions, with is in agreement with previous experiences of other authors. The technique is easy to leam, and when some proficiency is acquired, the patient can be ready for incision within lo min, after begin of induction. For upper abdominal surgery we consider it the method of choice, with cyclopropane as the general anesthetic Using assisted or controlled respirations it provides good abdominal relaxation and a "quiet obdomen", while it seems to interfer with the patients physiology les s than other techniques. For pelvic surgery this combination is less satisfactory although it also provided sometimes excellent working conditions. UOO 45-Lactate (Upjohn), a new local anestetic agent, enabled satisfactory intercostal nerveblocks Ior operations of 7 hrs duration. In the debilitated patient the safest and most flexible supplementation of the intercostal block seems to be very light inhalation anesthesia with cyclopropane via a cuffed endotrached tube, which is inserted under topical anesthesia in the conscious patient. This type of induction is always used for patients with abdominal distension and a possibly full stomach. The purpose of this report is to call attention to a useful and technically simple type of balanced anesthesia, which, as far as we know, rarely is applied as a routine.