Published online Aug 27, 2017. doi: 10.4240/wjgs.v9.i8.182
Peer-review started: November 29, 2016
First decision: February 20, 2017
Revised: March 20, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: August 27, 2017
A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient’s pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.
Core tip: This report demonstrated that transperitoneal rectal sheath block can be performed safely in achieving analgesia in patients undergoing laparoscopic colostomy. This transperitoneal rectal sheath block technique has the potential to become an additional postoperative regimen for various forms of laparoscopic abdominal surgery.