Postoperative Pain Management of Abdominal

Wall Tumors with Regional Anesthesia:

A Case Report

Afian Ishak Prasetyo

Case Report
◦ 71 y.o. Female
◦ Controlled Hypertension  Amlodipin 10 mg
◦ Overweight  IMT : 26.6 kg/m2

Lump on right side of Partial resection of the

stomach  3 years ago abdominal muscles

QLB and TAP blocks were

performed after the surgical
procedure was completed
Airway & Breathing
RR 20

Circulation
Disability
BP 130/70
Glucose : 129 mg/dL
HR 84

Abdomen CT

BW Density mass is not dense in the soft

Exposure
60 kg tissue region of the right lumbar,
Temp 36,7 C o

protruding into the peritoneal cavity

Preoperative Diagnosis:

• Right abdominal wall tumor malignant impression

Operation:

• Exploration laparotomy and tumor excision (partial excision of M. Serratus Anterior,

M. Serratus Posterior, M. Obliquus Internus, M. Obliquus Eksternus, M. Transversus
Abdominis, M. Levator Costarum)

Management

• GETA Anesthesia with an ETT ID of 7.0 mm in the LLD position during the
operation.
• After the operation  Regional Quadratus Lumborum Block (QLB) and Transversus
Abdominis Plane Block (TAP)
Patients in the LLD position  ultrasound guiding the border between M. Quadratus Lumborum
and M. Psoas. An injection of 20 ml of 0.25% Bupivacaine was given with a Spinal Neegle 25 G
needle
 The patient in the LLD position  ultrasound guidance on the upper part of the M. Transversus
Abdominis. An injection of 20 ml of 0.25% Bupivacaine was given with a Spinal Neegle 25 G needle.

After regional block with QL block and TAP block  multimodal analgesia: Paracetamol 500 mg/8
hours/oral, Gabapentin 100 mg/12 hours/oral, and Metamizole 750 mg/8 hours/oral.
 24 hours post QL and
TAP Blok
• NRS 1 when still and NRS
1 hour post 3 when moving  NRS 1-
QL and TAP 2 when moving
(paracetamol 500 mg/oral
block and gabapentin 100
• NRS 3 mg/oral)

6 hours post 48 hours post

QL and TAP QL and TAP
Blok Block
• NRS 1 when still • NRS 1 when still
and NRS 2-3 and NRS 2 when
when moving moving
Discussion
Conclussion
◦ The combination of peripheral nerve block TAP block and QLB block is one of the most developed
postoperative pain management modalities today.

◦ In this case report  combination of TAP block and QLB block made the patient feel minimal pain
after undergoing surgical procedures

◦ With the extent of the block from this combination of peripheral nerve blocks, it is hoped that it can
provide adequate analgesia for operations in the abdominal area.

◦ Suggestions are needed for future studies comparing the effectiveness of the combined TAP block and
QLB block with other pain management modalities such as epidurals or intravenous analgesics such as
fentanyl. With the data from this study, it is hoped that it can be a reference for pain management for
operations in the abdominal area.
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Quadratus lumborum block versus transversus abdominis plane
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