Nerve block for abdominal surgery: a technique of combined intercostal block-general anaesthesia (300 cases)

Abstract

For successful abdominal surgery satisfactory anaesthesia must be supplied; but the patient as well as the surgeon must be considered. Almost all the well -known anaesthetic agents can be used alone or combined to produce abdominal relaxation and enable the surgeon to perform his work with favourable operating conditions, but with what detriment to the patient?Post-operative mortality and morbidity must also be considered; and, indeed, in some cases the post-operative condition of the patient may well determine whether he will subsequently live or die."The operation was successful, but the patient died.'The Anaesthetist must therefore offer the surgeon optimum operating conditions, but at the minimum expense of the patient; and in abdominal surgery the anaesthetic desiderata might be considered briefly to consist of good muscular relaxation, absence of post -operative pulmonary and other) complications, minim= respiratory movements, and protection from operative shock. Although the effect of the anaesthetic - immediate or remote - on the patient roust always be the prime consideration, a method which is compatible with everyday working conditions for the busy anaesthetist, is obviously preferable. in other words it should be a practical technique, if possible, and not too time consuming, with a maximum percentage of success.in the past, the only means of producing good abdominal relaxation was by the potent lipoid soluble inhalational anaesthetics, ether and Chloroform. Later, spinal Analgesia was added to the anaesthetist's agents, and nerve Block in different forms; till at the present day we have the evolution of the various muscle relaxants.in the following pages nerve Block Anaesthesia in the various forms for abdominal surgery will be discussed, and in particular, intercostal Block, as part of a combined technique, with a summary and discussion of 300 cases.