Ketamine for analgesia of lumbosacral plexopathy secondary to the repair of an abdominal aortic aneurysm
DOI:
https://doi.org/10.18270/rsb.v9i2.2812Keywords:
Aneurysm, Ischemic, Polyneuropathy, Pain, KetamineAbstract
Introduction. Acute postoperative pain after abdominal aortic aneurysm is of high intensity; intraoperative complications may occur that increase nociception. Although opioids are the basis of analgesic treatment, their use is limited by the risk of respiratory depression and its potential for abuse. Ketamine is an option that provides analgesia and decreases the use of opioids.
Case presentation. 62-year-old male patient with abdominal aortic aneurysm who underwent endovascular and open repair. In the postoperative period he developed contralateral distal embolism with severe pain in the right buttock that required the stent explant and new revascularization. The pain was described as severe, incidental, with plantar allodynia, decreased proprioception and absence of pulses; electromyography reported moderate to severe axonal polyneuropathy with asymmetric compromise suggestive of plexus injury.
Discussion. Bilateral lumbosacral plexus ischemia was suspected, and ketamine was started (bolus = 1mg / kg plus infusion 0.5 mg / kg / hour), with significant improvement.
Conclusion. multimodal analgesia with ketamine is useful for postoperative analgesia in abdominal aneurysm repair surgery with improved analgesia and reduced opioid requirements.
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