{
  "abstract": "Application for ESRA Abstract Prizes: : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Patients with myasthenia gravis (MG) are at risk of myasthenic crisis and respiratory depression peri-operatively, with pain-induced stress as a potential trigger. Due to their sensitivity to neuromuscular blockers and opioids, minimising opioid use while ensuring adequate pain control is crucial. Regional anaesthesia can help achieve this balance. Here, we report a patient with MG undergoing lumbar laminoplasty, where total intravenous anaesthesia (TIVA) was combined with a thoracolumbar interfascial plane block (TLIPB) as an adjunct analgesic, reducing opioid use and ensuring safe peri-operative management. Written consent was obtained from the patient. A 60-year-old man (167 cm, 66 kg) with well-controlled MG (pyridostigmine 60 mg/day) underwent lumbar laminoplasty. TIVA with TLIPB was planned. After induction with propofol TCI, rocuronium 50 mg, and remifentanil, a Train-of-Four (TOF) count of 0 was confirmed, and intubation was performed. TLIPB was performed bilaterally at L4 under ultrasound guidance with 40 ml of 0.25% levobupivacaine. Anaesthesia was maintained with propofol (2.6 μg/ml) and remifentanil (0.1–0.15 μg/kg/min). Rocuronium 10 mg was additionally given intra-operatively. Fentanyl 100 μg was used for analgesia. Post-operatively, neuromuscular blockade was reversed with sugammadex 200 mg, and extubation was performed after confirming TOF ≥90% and adequate spontaneous breathing. Operation time was 1 hour 14 minutes. Post-operative analgesia included IV-PCA fentanyl (250 μg/24 h) and acetaminophen, maintaining an NRS of 3. No respiratory problems or myasthenic crisis symptoms occurred. TLIPB blocks posterior spinal nerve branches, providing effective analgesia from the dorsal midline to the lateral thorax and is useful for spinal surgeries spreading one to two vertebrae. While pain management is crucial in MG, opioid use must be minimised due to respiratory risks. TLIPB alone was insufficient but reduced opioid requirements, contributing to multimodal analgesia and safer peri-operative management. TLIPB may be a valuable option for pain management in MG patients undergoing spinal surgery.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, Japan"
      ],
      "name": "Shota Tanimoto"
    },
    {
      "affiliations": [
        "Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, Japan"
      ],
      "name": "Shakuo Tomoharu"
    },
    {
      "affiliations": [
        "Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, Japan"
      ],
      "name": "Yutaro Yanazaki"
    },
    {
      "affiliations": [
        "Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, Japan"
      ],
      "name": "Yumi Umetani"
    },
    {
      "affiliations": [
        "Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, Japan"
      ],
      "name": "Kenji Shida"
    }
  ],
  "title": "P172 Experience of using total intravenous anaesthesia with thoracolumbar interfascial plane block in patients with myasthenia gravis undergoing laminoplasty",
  "uid": "f2068f3a-2ba5-5742-ac4d-fb87d6de3715"
}