46 Regional anaesthesia where you don’t expect: neuraxial blockades for Endoscopic Submucosal Dissection procedure (ESD)

Background and AimsEndoscopic Submucosal Dissection (ESD) is an endoscopic procedure to remove gastrointestinal tumors [1]. It lasts 90 minutes or longer and general anaesthesia or deep sedation [2] are required to ensure comfort and immobility. Pain is evoked by intestinal insufflation and external compression manoeuvres. We evaluated the use of neuraxial blockades to perform colorectal ESD.MethodsWith informed consent, we performed neuraxial blocks for five colorectal ESD. Spinal anaesthesia (SA) and combined spinal-epidural (CSE) anaesthesia at T11-T12 level with spinal bolus of 0,3% ropivacaine, 4 ml + fentanyl 20mcg. Epidural anaesthesia (EA) at T10-T11 level with bolus of 0,4% ropivacaine, 12 ml + fentanyl 50mcg. Data regarded: patient; procedure; anaesthetic technique; SpO2; NIBP; intraprocedural pain (NRS); additional sedation or analgesia; patient’s and operator’s satisfaction.ResultsAll patients were elder and had comorbidities. Tumour site: 1 rectum; 2 descending colon; 2 ileocecal valve. Procedure’s duration: between 120 and 375 minutes. Anaesthesia: 2 SA, 1 CSE; 2 EA. SpO2: always stable between 97% and 100%. NIBP: 2 episodes of mild hypotension were registered. NRS: always 0; patients who received spinal anaesthesia complaint of abdominal pain after 200/240 minutes. They received additional IV fentanyl and deep propofol sedation. Patients’ and operators’ degree of satisfaction: 4 or 5 Results are summarized in table 1.ConclusionsCentral neuraxial blocks could be alternative techniques for colorectal ESD procedures, especially for fragile patients [3]. Procedure duration could not be accurately predicted, thus continuous epidural or CSE, should be preferred. Research trials are needed to corroborate our thoughts.