{
  "abstract": "Background and Aims Rectus sheath block (RSB) is moderately recommended in ERAS protocols for colorectal surgery. It is a simple and effective technique, easily incorporated into clinical practice. As an alternative to opioids, RSB helps reduce the incidence of postoperative nausea and vomiting (PONV) and ileus—key concerns in elderly patients. This case illustrates the benefits of regional analgesia over systemic opioids in an emergency surgical setting in a geriatric patient.Methods A 92-year-old female patient with personal history of ischemic heart disease, arterial hypertension and pacemaker placement due to bifascicular blockade underwent an emergency exploratory laparotomy for short bowel syndrome, following prior elective bowel resection with terminal ileostomy for colon cancer. During the surgery an ileo-ileal anastomosis was performed under total intravenous general anesthesia. Postoperative pain management started intraoperatively with paracetamol, metamizol and tramadol administration and followed a multimodal approach, including ultrasound-guided bilateral rectus sheath block with 20 ml of 0.2% ropivacaine.Results The patient achieved effective pain control without requiring systemic opioids neither in the post-anesthesia care unit nor throughout the postoperative period. Early oral intake and mobilization were possible, and no signs of postoperative ileus or PONV were observed. There were no complications related to the regional block.Conclusions In frail and elderly patients undergoing emergency colorectal surgery, analgesia using regional techniques such as RSB can significantly enhance recovery by minimizing gastrointestinal complications and opioid-related side effects. In this patient, considering the personal history of cardiovascular disease combined with the mortality associated with emergent laparotomies, makes cardiac stress reduction offered by regional analgesia even more relevant. This case supports the feasibility and clinical benefit of RSB in elderly patients, highlighting its safety and positive impact on recovery when used as part of a multimodal analgesic approach.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology Department, ULS Santa Maria, Lisbon, Portugal"
      ],
      "name": "Joana Antunes"
    },
    {
      "affiliations": [
        "Anesthesiology Department, ULS Santa Maria, Lisbon, Portugal"
      ],
      "name": "Rui Macedo-Campos"
    },
    {
      "affiliations": [
        "Anesthesiology Department, ULS Santa Maria, Lisbon, Portugal"
      ],
      "name": "Miguel Ferreira"
    }
  ],
  "title": "P202 Bilateral rectus sheath block for postoperative analgesia in a 92-year-old patient: a case report",
  "uid": "26089902-4374-5934-82cb-3a67d611cfa6"
}