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P140 Excision of a pleiomorphic malignancy with myxoid features under surgical bilateral anterior quadratus lumborum block for an elderly with multilpe comorbidities: a case report
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P140 Excision of a pleiomorphic malignancy with myxoid features under surgical bilateral anterior quadratus lumborum block for an elderly with multilpe comorbidities: a case report
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P140 Excision of a pleiomorphic malignancy with myxoid features under surgical bilateral anterior quadratus lumborum block for an elderly with multilpe comorbidities: a case report
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Journal Article
P140 Excision of a pleiomorphic malignancy with myxoid features under surgical bilateral anterior quadratus lumborum block for an elderly with multilpe comorbidities: a case report
2025
Overview
Background and AimsMyxoid pleiomorphic liposarcoma is a rare type of liposarcoma that is very aggressive in nature. The curative treatment involves wide excision. In elderly patients with multiple comorbidities, there is no adequate time to fully optimize the patient preoperatively. Peripheral nerve block (PNB) provides an alternative choice for patients who are not good candidates for neuraxial or general anesthesia.MethodsAn 87 year old male was admitted for wide excision of a likely malignant back mass with split thickness skin grafting. Patient has heart failure, chronic kidney disease, gout, benign prostatic hyperplasia, dementia, and pleural effusion. Patient previously had tuberculosis and COVID. He also underwent a coronary artery bypass. Paient was started on minimal sedation prior to blocking. Ropivacaine 0.25% with epinephrine was given at 20 mL for each block. The anesthetic techniques done were bilateral anterior quadratus lumborum(QL) and right subgluteal sciatic nerve blocks. Sensory block was noted from T4 to L5 dermatomal levels. A decrease of 20% from the baseline blood pressure was also observed. Patient tolerated the procedure well with minimal postoperative pain, and was discharged 3 days after.ResultsAnterior QL block is an interfascial plane block. Ropivacaine may reach the thoracic paravertebral space and the lumbar plexus since the anterior layer of throcalumbar fascia is continuous with the endothoracic fascia and fascia iliaca respectively extending the usual coverage. Since the source of the skin graft will involve the posterior thigh, a subgluteal sciatic nerve block was added. Since the proximity of the subgluteal sciatic nerve to the posterior femoral cutaneous nerve is quite close, it is also expected for the local anesthetic to cover the posterior thigh.ConclusionsPNB provides a loophole for patients at risk for postoperative morbidity with the traditional techniques. As long as the anatomy is understood, selective blockade is possible without endangering the other organs.
Publisher
BMJ Publishing Group LTD
Subject
