2012 Volume 72 Issue 6 Pages 620-627
Little attention has been given to anesthesia when creating and/or removing a Peritoneal Access (PA). The purpose of this study was to evaluate the usefulness of a Rectus Sheath Block (RSB), Transversus Abdominis Plane block (TAP) or combined procedure in access surgery of Peritoneal Dialysis. In PA surgery, analgesia in the abdominal cavity is not needed because the PA catheter tip is guided to the appropriate position based on the patient's visceral sense. Thus it might be inferred that anesthesia is suitable for PA surgery. Ninety-eight adults underwent catheter insertion PDI, catheter removal PDR, or simultaneous PDRI (68/22/8 each), and 56 patients received infiltration anesthesia, 12 block anesthesia in PDI, and 17/5 in PDR, 5/3 in PDRI. Methods: For infiltration anesthesia, local anesthetic was administered by the surgeon as requested by the patient, whereas, an RSB and/or TAP block were performed unilaterally by the anesthesiologist. When using infiltration anesthesia, the respective average dosage of anesthetic was 32.5, 24.8, and 50.8ml in PDI, PDR, and PDRI, respectively; anesthetic exceeded 20ml in 58 cases (74%). Significant differences were recognized in PDRI vs. PDR, PDRI vs. PDI, and PDI vs. PDR. The combination of RSB and TAP block was used for 16 (80%), infiltration anesthesia was required in 14 (70%). There was no significant difference in surgical time and in the number of requests for analgesic treatment by the method of anesthesia. It seemed that a sufficiently anesthetized area is obtainable with RSB and TAP block under limited anesthetic dosage. The abdominal wall block is useful and is suggested to be the best method for PA operation.