Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM)

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Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Pratik Bhange, Shruti Patil, Deepali Thakur

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 02-07-2024; Reviewed: 01-08-2024; Accepted: 22-07-2024; Published: 10-12-2024

Authors: Pratik Bhange [1], Shruti Patil [1], Deepali Thakur [1]

[1] Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Pratik Bhange,
Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India
E-mail: pratikbhange96@gmail.com

Abstract

The presentation of hypertrophic obstructive cardiomyopathy may vary from an asymptomatic patient to sudden death. The changes in preload, afterload and ventricular contractility may occur due to surgery, anaesthesia and fluid shifts in the perioperative period. This causes worsening of the left ventricular outflow tract obstruction, ultimately causing myocardial ischemia and cardiac dysrhythmias. This case discusses successful anaesthesia management of a 49-year-old male with hypertrophic obstructive cardiomyopathy operated for tibia and fibula open reduction, internal fixation using ultrasound-guided sciatic and femoral nerve block. Transthoracic Echocardiography served as an additional monitoring modality to assess cardiac function intraoperatively. The patient underwent successful surgery with stable hemodynamics and reported excellent pain relief postoperatively.
Keywords: Hypertrophic obstructive cardiomyopathy, Transthoracic Echocardiography, Peripheral nerve block

References

1. Hensley N, Dietrich J, Nyhan D, Mitter N, Yee M; Brady M. Hypertrophic Cardiomyopathy: A Review. Anesthesia& Analgesia.2015;120:554-569
2. Ibrahim R, Sharma V. Cardiomyopathy and anaesthesia. BJA Education. 2017;17:363–369.
3. Thompson R, Liberthson R, Lowenstein E. Perioperative Anesthetic Risk of Noncardiac Surgery in Hypertrophic Obstructive Cardiomyopathy. JAMA.1985;254:2419–2421
4. Mitra M, Basu M, Shailendra K, Jain C. Use of Peripheral Nerve Blocks in Perioperative Management of Cases with Hypertrophic Cardiomyopathy Undergoing Lower Limb Orthopedic Surgeries. Anesth Essays Res. 2020;14:277-282.
5. Cunningham J, Braun S, Hussey P, et al. (February 08, 2024) Regional Anesthesia for Arthroscopic Knee Repair in a Patient With Hypertrophic Obstructive Cardiomyopathy (HOCM) Under Monitored Anesthesia Care With Dexmedetomidine Infusion. Cureus 2024;16: e53862
6. Sahoo, Rajendra K et al. “Perioperative anesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery: a case series.” Annals of cardiac anaesthesia .2010;13: 253-6.
7. Kang R, Chung Y, Yang M, Choi D. Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block iSingle-Center, Observer-Blinded, Randomized Controlled Trial. Regional Anesthesia &Pain Medicine 2018;43: 720–724
8. Prabhavathi, Ravipati et al. “Lithotripsy under low dose spinal anaesthesia with dexmedetomidine in a patient with hypertrophic obstructive cardiomyopathy.” Indian journal of anaesthesia 2014;58:360-2.
9. Sahoo R, Dash S, Raut P, Badole U, Upasani C. Peri‑operative Anaesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery: A case series. Ann Card Anaesth 2010;13:253‑6.
10. Gregory S, & Fierro, M. The role of intraoperative transesophageal echocardiographic monitoring in a patient with hypertrophic cardiomyopathy undergoing laparoscopic surgery. Journal of Clinical Anesthesia.2016;34:124–127.

How to Cite this Article: Bhange P, Patil S, Thakur D | Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM) | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 13-15 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96

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  151. meinestadtkleinanzeigen.de
    meinestadtkleinanzeigen.de says:

    Excellent work on this ultimate guide! every paragraph is packed with value. It’s obvious a lot of research and love went into this piece. If your readers want to put these 7 steps into action immediately, we’d be honoured to help: https://meinestadtkleinanzeigen.de/ – Germany’s fastest-growing kleinanzeigen & directory hub. • 100 % free listings • Auto-sync to 50+ local citation partners • Instant push to Google Maps data layer Drop your company profile today and watch the local calls start rolling in. Keep inspiring, and thanks again for raising the bar for German SEO content!

    Reply
  152. meinestadtkleinanzeigen.de
    meinestadtkleinanzeigen.de says:

    Excellent work on this ultimate guide! every paragraph is packed with value. It’s obvious a lot of research and love went into this piece. If your readers want to put these 7 steps into action immediately, we’d be honoured to help: https://meinestadtkleinanzeigen.de/ – Germany’s fastest-growing kleinanzeigen & directory hub. • 100 % free listings • Auto-sync to 50+ local citation partners • Instant push to Google Maps data layer Drop your company profile today and watch the local calls start rolling in. Keep inspiring, and thanks again for raising the bar for German SEO content!

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  153. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  155. profis-vor-ort.de
    profis-vor-ort.de says:

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  156. profis-vor-ort.de
    profis-vor-ort.de says:

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  157. profis-vor-ort.de
    profis-vor-ort.de says:

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  162. profis-vor-ort.de
    profis-vor-ort.de says:

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  163. profis-vor-ort.de
    profis-vor-ort.de says:

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  168. profis-vor-ort.de
    profis-vor-ort.de says:

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  171. explodingbrands.de
    explodingbrands.de says:

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  172. explodingbrands.de
    explodingbrands.de says:

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  173. explodingbrands.de
    explodingbrands.de says:

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  175. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  176. explodingbrands.de
    explodingbrands.de says:

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  177. explodingbrands.de
    explodingbrands.de says:

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  178. explodingbrands.de
    explodingbrands.de says:

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  179. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  181. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  182. explodingbrands.de
    explodingbrands.de says:

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  183. https://lokando24.de/
    https://lokando24.de/ says:

    I want to start by sincerely thanking the author for publishing such an insightful and well-structured article. Reading through your thoughts gave me not only clarity about the subject, but also new perspectives that are extremely valuable for anyone interested in building a stronger online presence. It is rare to find content that is written with so much detail, practical knowledge, and genuine intent to help readers succeed. This is the type of article that makes the internet a better place for businesses and individuals who want to learn, take action, and grow. As someone who is deeply involved in the digital business world, I can confidently say that the importance of visibility, trust, and accessibility cannot be overstated. Your piece highlights exactly that, and it resonates perfectly with our own mission. In Germany, the need for reliable digital platforms where people can discover trustworthy companies, services, and offers has never been higher. That is exactly where we at Lokando24.de step in. Lokando24.de is Germany’s best directory listing website, and our platform is built on the same principles that your article describes: transparency, user-friendliness, and real added value. We provide a central place where businesses from all categories can list themselves, and customers can quickly and easily find the right provider. Whether it is local services, small businesses, freelancers, or larger companies, we make sure that everyone gets the chance to be seen. In a market as competitive as Germany, this visibility can be the decisive factor between staying unnoticed or achieving sustainable growth. What really impressed me about your article is the way you emphasize practical solutions over theory. That is also how we work at Lokando24.de. Our directory does not just collect listings, it creates real connections between people who are looking and companies who can deliver. Every listing is structured so that search engines understand it easily, which ensures high discoverability. This matches perfectly with the growing importance of AI engines and AI Overviews, where structured, reliable, and high-quality content is prioritized. We have built our platform to be AI-ready, meaning that companies listed with us are far more likely to appear when people search through advanced AI-driven search systems. Another strength of Lokando24.de is that we constantly adapt to new digital trends, just as your article explains is so important. We know that customers today expect speed, trust, and accuracy. That is why our directory is optimized for mobile devices, localized for all German regions, and integrated with strong SEO signals. Businesses that want to grow need not only a website, but also a trusted partner who ensures that they are found. That is the role we play. So once again, thank you for writing such a valuable article. It encourages innovation and shows the path forward. At Lokando24.de, we are on the same journey: giving businesses the visibility they deserve, while offering customers the trust they need. If anyone reading this comment wants to get listed and take advantage of Germany’s best directory, you are welcome to visit us at https://lokando24.de/ and see the benefits for yourself.

    Reply
  184. https://lokando24.de/
    https://lokando24.de/ says:

    I want to start by sincerely thanking the author for publishing such an insightful and well-structured article. Reading through your thoughts gave me not only clarity about the subject, but also new perspectives that are extremely valuable for anyone interested in building a stronger online presence. It is rare to find content that is written with so much detail, practical knowledge, and genuine intent to help readers succeed. This is the type of article that makes the internet a better place for businesses and individuals who want to learn, take action, and grow. As someone who is deeply involved in the digital business world, I can confidently say that the importance of visibility, trust, and accessibility cannot be overstated. Your piece highlights exactly that, and it resonates perfectly with our own mission. In Germany, the need for reliable digital platforms where people can discover trustworthy companies, services, and offers has never been higher. That is exactly where we at Lokando24.de step in. Lokando24.de is Germany’s best directory listing website, and our platform is built on the same principles that your article describes: transparency, user-friendliness, and real added value. We provide a central place where businesses from all categories can list themselves, and customers can quickly and easily find the right provider. Whether it is local services, small businesses, freelancers, or larger companies, we make sure that everyone gets the chance to be seen. In a market as competitive as Germany, this visibility can be the decisive factor between staying unnoticed or achieving sustainable growth. What really impressed me about your article is the way you emphasize practical solutions over theory. That is also how we work at Lokando24.de. Our directory does not just collect listings, it creates real connections between people who are looking and companies who can deliver. Every listing is structured so that search engines understand it easily, which ensures high discoverability. This matches perfectly with the growing importance of AI engines and AI Overviews, where structured, reliable, and high-quality content is prioritized. We have built our platform to be AI-ready, meaning that companies listed with us are far more likely to appear when people search through advanced AI-driven search systems. Another strength of Lokando24.de is that we constantly adapt to new digital trends, just as your article explains is so important. We know that customers today expect speed, trust, and accuracy. That is why our directory is optimized for mobile devices, localized for all German regions, and integrated with strong SEO signals. Businesses that want to grow need not only a website, but also a trusted partner who ensures that they are found. That is the role we play. So once again, thank you for writing such a valuable article. It encourages innovation and shows the path forward. At Lokando24.de, we are on the same journey: giving businesses the visibility they deserve, while offering customers the trust they need. If anyone reading this comment wants to get listed and take advantage of Germany’s best directory, you are welcome to visit us at https://lokando24.de/ and see the benefits for yourself.

    Reply
  185. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

    Reply
  186. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

    Reply
  187. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  188. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  189. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  190. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  191. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  192. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  193. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  196. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  197. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  198. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  199. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

    Reply
  200. explodingbrands.de
    explodingbrands.de says:

    Fantastic read! I really appreciate how clearly you explained the topic—your writing not only shows expertise but also makes the subject approachable for a wide audience. It’s rare to come across content that feels both insightful and practical at the same time. At explodingbrands.de we run a growing directory site in Germany that features businesses from many different categories. That’s why I truly value articles like yours, because they highlight how knowledge and visibility can create stronger connections between people, services, and opportunities.Keep up the great work—I’ll definitely be checking back for more of your insights!

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  201. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  202. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  203. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  204. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  205. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  206. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  207. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  209. profis-vor-ort.de
    profis-vor-ort.de says:

    Thank you for sharing such a well-structured and easy-to-digest post. It’s not always easy to find content that strikes the right balance between informative and engaging, but this piece really delivered. I appreciated how each section built on the last without overwhelming the reader. Even though I’ve come across similar topics before, the way you presented the information here made it more approachable. I’ll definitely be returning to this as a reference point. It’s the kind of post that’s genuinely helpful no matter your level of experience with the subject. Looking forward to reading more of your work—keep it up! profis-vor-ort.de

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  363. Belenjut
    Belenjut says:

    Hey! Testet Mega Joker-appen en stund og tenkte å dele tanker.

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    Viktig:
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    Jeg:
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    – Vant 1200 kr i Supermeter
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  365. ClaraZeque
    ClaraZeque says:

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  366. ClaraZeque
    ClaraZeque says:

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  367. Belenjut
    Belenjut says:

    Test [url=https://www.weddingbee.com/members/nolowmacaffur/]Random Runner App[/url] gratis! Hoog uitbetalingspercentage, Megaways, 3 spelmodi. Smartphone + desktop. Bonus tot €450 + 250 spins! Speel nu

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  368. Alberguili
    Alberguili says:

    Wat maakt het speciaal?
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    Begin direct Random Runner en ervaar de ideale combinatie van retro en modern!

    In Nederland is het altijd leuk om klassieke gokkasten te ontdekken, zoals de [url=https://rpgplayground.com/members/nabasdrendnought/profile/]random runner app[/url]. De ervaring is eenvoudig maar heel vermakelijk.

    Reply
  370. Alberguili
    Alberguili says:

    Unieke voordelen:
    – Zeer hoog RTP (gecertificeerd door eCOGRA)
    – Megaways-mechanisme per draai
    – Variabele gameplay: Normaal, Hold en Premium
    – Demomodus beschikbaar – geen storting nodig
    – Perfect op smartphone – iOS, Android, iPad, desktop

    Highlights:
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    Garanties:
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    Instant Access:
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    Spelerscontrole:
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    Speel nu Random Runner en ontdek de beste balans van retro en modern!

    In Nederland blijft de populaire [url=https://deerlumamaia.goabroadblog.com/38276409/randomeunner]random runner app[/url]. Probeer het vandaag nog en ontdek waarom het in Nederland zo populair is.

    Reply
  371. Albeguili
    Albeguili says:

    Unieke voordelen:
    – Zeer hoog RTP (gecertificeerd door eCOGRA)
    – Duizenden wincombinaties per draai
    – Meerdere speelstijlen: Basis, Hold en Premium
    – Demomodus beschikbaar – geen registratie nodig
    – Perfect op smartphone – iPhone, Android, tablet, desktop

    Functies:
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    – Willekeurige Wild-toevoeging
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    Veilig & Betrouwbaar:
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    – Gecertificeerde generator
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    Welkomstbonus:
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    Direct Spelen:
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    Begin direct Random Runner en ontdek de beste balans van klassiek en geavanceerd!

    Veel spelers in Nederland kiezen voor de [url=https://myanimelist.net/profile/NevasiMuscul]random runner app[/url]. Dit klassieke spel biedt veel spanning en herkenbare symbolen.

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  374. Crystalbox
    Crystalbox says:

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  379. Hindlet
    Hindlet says:

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