An 84-year-old female (body weight 56 kg, ASA status III) was scheduled for right artificial femoral head replacement. Her pelvic X-ray revealed a right intertrochanteric fracture. She had hypertension for 35 years and chronic obstructive pulmonary disease (COPD) for 20 years. She took daily oral nifedipine for hypertension, but did not take any treatment for COPD. The result of pulmonary function test showed that the FEV1/FVC was 35% and the bronchodilator test was negative. Cardiac Doppler ultrasonography indicated moderate pulmonary artery hypertension. A chest X-ray revealed pulmonary infection of bilateral lower lobes. Low-molecular-weight heparin was used for prevent thrombus formation at 4000IU per day and stopped 24 hours before surgery. The preoperative visual analogue scale (VAS) score of this patient was 6. The ultrasound guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks were performed on this patient as described in the Methods section, and 25 mL of 0.4% ropivacaine was used for these blocks. The success of these blocks was confirmed by pinprick test. The time of surgery was 42 minutes. She did not complain any painful during surgery and in postanesthesia care unit (PACU). As postoperative analgesia was achieved by patient-controlled analgesia (PCA), the postoperative VAS scores were 0 to 1. This patient discharged on the fifth day after surgery. No postoperative complication was reported with her.
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.