{
  "abstract": "Background and Aims Major organ transplantation cases are often associated with poorly controlled acute postoperative pain. This can negatively impact hemodynamics, myocardial oxygen demand, incidence of postoperative delirium, time to extubation, and length of intensive care unit (ICU) stay. Traditionally, high-dose opioids were a mainstay of treatment, however, their side effect profile and dependency risk limit long-term use. Considering this, we present two cases advocating for alternative regional analgesia techniques: (1) in a high-risk multi-organ transplant patient and (2) in a patient undergoing combined open cardiac surgery with abdominal organ transplantation. The first patient who underwent a dual liver and bilateral orthotopic lung transplant, received bilateral serratus plane blocks at T5 and external oblique intercostal (EOI) plane blocks at T6 and T7 levels with bupivacaine 0.25% and liposomal bupivacaine on postoperative day (POD) 3. He was successfully extubated immediately post-block with declining daily oral morphine equivalents (OME) from POD3 to POD5. The second patient, who underwent a 2-vessel coronary artery bypass graft via midline sternotomy and orthotopic liver transplantation, received superficial parasternal at T2 and T4 and EOI plane blocks at T6 and T7 on POD1. He was also successfully extubated immediately following the block with declining daily OME requirements.Conclusions All fascial plane blocks were performed with the patient supine. Each regional technique was chosen based on somatic coverage of the surgical incision. The sonoanatomy for each block was easily identified and performed cautiously on anticoagulated patients without altering hemodynamics. Because of the extensive surgical incision, it was essential to be mindful of the safe upper limit of local anesthetic dosage. Due to concerns and issues with multiple catheters, we opted to use long-acting bupivacaine for these cases for prolonged postoperative analgesia. In conclusion, it is beneficial to advocate for alternate regional techniques for these high-risk multi-organ transplant patients.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA"
      ],
      "name": "Hari Kalagara"
    },
    {
      "affiliations": [
        "Mayo Clinic, Jacksonville, USA"
      ],
      "name": "Cassidy West-Santos"
    },
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA"
      ],
      "name": "Sindhuja Nimma"
    }
  ],
  "title": "EP055 Combination regional anesthesia techniques for patients undergoing simultaneous double organ transplantation: case reports",
  "uid": "46528ca2-8dfb-5bf9-bf1c-083eeeaf9642"
}