Combination of Rectus Sheath Block and Subcostal Transversus Abdominis Plane Block as the Sole Anesthesia for an Open Gastrostomy in a High-risk Patient

Truncal blocks are widely used for postoperative analgesia, but are rarely used for surgical anesthesia. Herein is reported the success of an open gastrotomy under truncal blocks in a patient for whom general anesthesia and neuraxial blockade were undesirable. A 79-year-old man, with advanced esophageal cancer presented with several comorbidities; including cardiomyopathy, ischemic heart disease, and prior cerebral infarction. Difficulty in airway management was anticipated due to the mass’s compression on the airway. Anesthesia was achieved using a combination of truncal blocks; this being the rectus sheath block and the subcostal transversus abdominis plane block, supplemented by intravenous fentanyl for managing visceral pain.