Ultrasound–guided abdominal wall blocks as sole anesthetic technique in a high-risk patient undergoing CAPD catheter insertion with umbilical hernia repair: A case report

Abstract

Background: Patients with End Stage Renal Disease (ESRD) often present with complex comorbidities that significantly increase perioperative morbidity and mortality. General anesthesia in such patients may result in haemodynamic instability, delayed drug clearance and postoperative pulmonary complications. Regional anesthesia techniques in such patients provide an effective alternative with minimal systemic effects. We report a case of a 55-year-old female patient with ESRD on maintenance haemodialysis complicated by ischemic heart disease, right ventricular dysfunction and recurrent episodes of atrial fibrillation and chronic pulmonary embolism was scheduled for CAPD (Continuous Ambulatory Peritoneal Dialysis) catheter placement with concurrent umbilical hernia repair. Considering the high anesthetic risk, the procedure was successfully performed using bilateral rectus sheath block and transversus abdominis plane (TAP) block. The patient remained hemodynamically stable intraoperatively and had an uneventful postoperative recovery with adequate analgesia. This case highlights the feasibility and safety of ultrasound-guided abdominal wall blocks as the sole anesthetic technique in high-risk patients with significant cardiopulmonary comorbidities undergoing abdominal procedures.