Hemiarthroplasty performed under transversus abdominis plane block in a patient with severe cardiorespiratory disease

This report describes the use of a transversus abdominis plane block as the main anaesthetic technique for the performance of a hemiarthroplasty in a patient with severe cardiac and respiratory dysfunction, for whom both general and spinal anaesthesia carried considerable risks. The block was performed in the triangle of Petit posterior to the mid-axillary line, using a landmark technique. A combination of lidocaine 1% (20ml) and bupivacaine 0.5% (20ml) was administered. A low-dose propofol infusion was used intra-operatively to relieve anxiety, although the patient breathed spontaneously throughout the procedure and responded to voice commands. The surgery was completed successfully without the need for further analgesia. The patient was alert and comfortable in recovery. First opioid administration was 12h after surgery. The patient was subsequently discharged to a nursing home, where he succumbed to his primary respiratory disease sixmonths later.