Efficacy of Ultrasound Guided Bilateral Subcostal Tap Block and Ultrasound Guided Celiac Plexus Block Using a Novel Supra Celiac Approach for Anaesthesia during Open Palliative Feeding Jejunostomy- A feasibility Study

Background: General or Regional anaesthesia are the most common anaesthetic techniques practiced for open palliative feeding jejunostomy (PFJ) for advanced esophageal cancer. However, it is not devoid of technique specific complications accounting to perioperative morbidity and mortality. In this study, a combination of ultrasound guided bilateral Subcostal Transverse abdominis plane (SC TAP) block and a novel supraceliac approach to ultrasound guided Celiac Plexus (CP) block was evaluated for its safety and efficacy in providing surgical anaesthesia for open PFJ. Methods: This prospective feasibility study was conducted in 15 patients scheduled for open PFJ. We performed bilateral ultrasound guided SC TAP block and ultrasound guided CP block using a novel supraceliac approach to attain surgical anaesthesia for open PFJ. The variables such as percentage of patients requiring intraoperative and postoperative rescue analgesics and pain scores, block success rate, block performance time, duration of postoperative analgesia and side effects were recorded. Results: Percentage of patients who required rescue analgesics in the intraoperative period and postoperative period were 6.6% and 20% respectively, with a block success rate of 100%. Intraoperative pain scores measured by verbal rating scale was 1 in all the patients except one patient who had a score of 2. Median postoperative pain scores measured by visual analog scale were 0 for first 12 postoperative hours. The side effects were minimal and manageable. Conclusion: The combination of bilateral ultrasound guided SC TAP block and the novel ultrasound guided supraceliac approach to CP block was a feasible, efficacious, and safe technique to provide surgical anaesthesia for open PFJ in patients with advanced esophageal malignancy.