Locoregional Anaesthesia for Laparotomy: A Literature Review and Subsequent Case Series Highlighting the Potential of an Alternative Anaesthetic Technique

Abstract

Laparotomy is a surgical incision utilised in both emergency and elective scenarios to gain access to abdominal surgery. General anaesthesia is usually necessitated due to the substantial insult of the approach and to facilitate organ relaxation and paralysis. However, this brings with it the need for an assessment of the suitability of the anaesthetic technique, with a large number of patients having comorbidities significant enough to exclude them from surgery. Locoregional anaesthesia, provided via spinal, epidural, or a combined approach offers a means of providing anaesthesia that places a reduced level of strain on patients' cardiorespiratory function. We review the existing literature on the topic of so-called "awake laparotomy" performed with locoregional anaesthesia and present a case series including both elective and emergency procedures.

Keywords: awake laparotomy; epidural anaesthesia; laparotomy decision; locoregional anesthesia; spinal anaesthesia.

Figure 1. Portal venous phase CT abdomen – axial view demonstrating small bowel obstruction with jejunal and ileal dilation and the transition point

Figure 2. Axial and coronal portal venous phase CT images demonstrating a high-grade small bowel obstruction, with a transition point noted in the right iliac fossa

Figure 3. Portal venous phase CT abdomen - axial view showing circumferential caecal wall thickening