Case 3: A 26 years old female (weight 47 kg, ASA status II) was scheduled for left total hip arthroplasty. She was diagnosed with ankylosing spondylitis 14 years ago, with pain on almost all major joints of her body. She could not stand or walk because of bilateral femoral head necrosis. She had a family history of ankylosing spondylitis, with her father also suffered from this disease. Physical examination revealed rigidity of neck and left hip joint. X-ray of the thoracic and lumbar vertebrae reported rigidity of the spine, calcification of interspinous ligament. X-ray of bilateral sacra-iliac joints, hip joints, knees and ankles reported narrow joint space, osteoproliferation, bone defect and joint deformity. The chest X-ray reported texture enhancement of bilateral lungs and infection of right lower lobe.
A 68-year-old female patient (161 cm, 50 kg) with a 21-mm large mass in the upper pole of the right kidney was scheduled for RAPN peritoneal approach. The anesthetic method and block were similar to those in case 1.\nThe operative and anesthetic times were 271 and 326 min, respectively. The patient intraoperatively received intravenous fentanyl 200 μg and acetaminophen 750 mg. The surgical procedure was different from that of case 1 with respect to the placement of a single and surgery time extension. Postoperative pain was managed in the ward using continuous intravenous infusion of 25 μg/h fentanyl combined with 25 μg fentanyl for IV-PCA with 10-min lockout.\nA pinprick test performed at 2 h after surgery revealed that the anesthetized dermatomal range was Th7–Th12. The NRS scores were 3-0-0-0/10 at rest and 5-1-1-3/10 on movement at 2, 12, 24, and 48 h after surgery, respectively. Acetaminophen was administered once at POD 0. IV-PCA was stopped at 67 post-surgery hours. The total fentanyl amount post-operatively used was 2425 μg. She was discharged without adverse events at 7 days after surgery.