Case of the week: Laparotomy for a kidney resection
A male subject, 54 years old, underwent a surgery.
It was a laparotomy for a kidney resection.
The analgesia was done through epidural catheter.
Bupivacaine was used to avoid opioids.
Opioids were not used because they may contribute to recurrence, you also have a better control of surgical stress and avoid interleukins release that are associated with post operation pain and cancer relapse.
The bolus of bupicavaine was already there 10 minutes before the incision.
Thanks to that, the ANI is 100 as the sympathetic activity is blocked. The ANI is 100 here because he is sleeping. It could have been between 50-70 if the patient was awake and it would have been lower than that if the patient was awake and anxious.
After the incision, the ANI does not fall, the block is working perfectly.
Everything is parasympathetic here so there is no surgical stress for the patient, no adrenergic response so haemodynamic stability is expected and, the most important is that there is no release of cytokines so there is no inflammation and no post op pain, there are less risks of cognitive dysfunction, cancer recurrence…