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Ultrasound-Guided Transversus Abdominis Plane/Genitofemoral Blocks for a Patient Receiving Extracorporeal Life Support

Brisard, Laurent MD; Belaidi, Mustapha MD; Bizouarn, Philippe MD, PhD; Courbe, Athanase MD; Roussel, Jean-Christian MD, PhD; Rozec, Bertrand MD, PhD

doi: 10.1213/XAA.0000000000000030
Case Reports: Case Report

Extracorporeal life support may be used in patients with refractory cardiogenic shock. The femoral venoarterial route can be used for implanting cannulae in patients who are hemodynamically unstable. Here we describe the use of an ultrasound-guided transversus abdominis plane block supplemented with the femoral component of the genitofemoral nerve as the anesthesia technique for peripheral cannulation of the femoral vessels in a patient with severe acute heart failure after myocardial infarction with ST-segment elevation. The procedure was performed using 40 mL of a 50:50 mixture of 0.5% levobupivacaine and 2% lidocaine (30 mL for transversus abdominis plane and 10 mL for genitofemoral block) associated with low-dose remifentanil infusion during spontaneous breathing. A left ventricular assist device was successfully implanted 4 days later.

From the *CHU de Nantes, Service d’Anesthésie et de Réanimation Chirurgicale; and CHU de Nantes, Service de chirurgie cardiaque, Institut du Thorax, Hôpital Nord Laënnec, Boulevard Jacques Monod, Nantes, France.

Accepted for publication January 15, 2014.

Funding: This work was supported by the Department of Anesthesiology.

The authors declare no conflicts of interest.

Address correspondence to Laurent Brisard, MD., C.H.U. de Nantes, Service d’Anesthésie et de Réanimation Chirurgicale, Hôpital Nord Laënnec, Boulevard Jacques Monod, Nantes, F-44093 France. Université de Nantes, Faculté des sciences pharmaceutiques, Laboratoire Expérimental de Simulation en Médecine Intensive de l’Université de Nantes (LESiMU de Nantes), 9 rue Bias Nantes Cedex 1, F-44035 France. Address e-mail address: laurent.brisard@chu-nantes.fr.

© 2014 International Anesthesia Research Society