Combined psoas compartment and sciatic nerve block for lower limb surgery: An alternative anesthetic option in high-risk geriatric patients

Malik, Sunny; Krishna, Deepak; Malik, Shraddha

doi:10.4103/2394-6954.163090

Cited by 3 publications

(4 citation statements)

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“…The knowledge of anatomy is the most important prerequisite for giving nerve blocks. [4] Advances in regional block are one of the safest modalities in surgical anaesthesia and pain management and enhance the potential for success, rapid postoperative recovery and patient safety. [17] Since no starving or special preparation is required regional block is preferred in trauma procedures as in emergency settings patient is generally full stomach.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Advancement in the newer techniques such as peripheral nerve stimulator and ultrasound anesthesia has shifted from general anesthesia (GA) and central neuraxial blockade for isolated limb surgery to peripheral nerve blocks. [4] But still there is no consensus on whether certain types of patients benefit more from a general, regional or mixture of the two types of anesthesia and anaesthesiologists have different priorities and preferences. [5] The onset of action of a peripheral nerve block is longer than a spinal (subarachnoid block), and the success rate of a satisfactory block is generally lower than for neuraxial blocks.…”

Section: Introductionmentioning

confidence: 99%

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Orthopedic Surgeries of Lower Limb under Combined Femoral and Sciatic Nerve Block: A Comparative Study in RMCH & RC

Kumar

Kaushik

2018

ijirms

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The best option for life-saving operations is regional block anesthesia where both general and central neuraxialanesthesia are risky. It does not require fasting, special preparation, or preoperative optimization and can be given in emergency conditions.[1] Also peripheral nerve blocks (PNBs) are preferred for lower limb surgeries and orthopaedic surgeries because of peripheral location of surgical site and the potential to block pain pathways at multiple levels.[2] Furthermore, better cardio respiratory stability is observed with peripheral nerve blocks as central neuraxial blockade is having side effects such as hypotension, bradycardia, meningitis, postdural puncture headache, neurological deficit, etc.[3] Advancement in the newer techniques such as peripheral nerve stimulator and ultrasound anesthesia has shifted from general anesthesia (GA) and central neuraxial blockade for isolated limb surgery to peripheral nerve blocks.[4] But still there is no consensus on whether certain types of patients benefit more from a general, regional or mixture of the two types of anesthesia and anaesthesiologists have different priorities and preferences.[5] The onset of action of a peripheral nerve block is longer than a spinal (subarachnoid block), and the success rate of a satisfactory block is generally lower than for neuraxial blocks. However the cardiovascular stability and postoperative pain relief these regional blocks provide make them worthwhile techniques to perform especially in the critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Orthopedic Surgeries of Lower Limb under Combined Femoral and Sciatic Nerve Block: A Comparative Study in RMCH & RC

Kumar

Kaushik

2018

ijirms

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“…11 Malik et al used combined psoas compartment block and sciatic nerve block for lower limb surgery in high risk geriatric patients and reported successful management of these patients. 12 Petchara et al used combined lumbar and sacral plexus block in 70 patients undergoing early hip fracture surgery using neurostimulation except for patients with difficult landmarks or at risk for bleeding complications; clinical efficacy without serious complications was demonstrated based on the results of the study. 13 De Visme et al compared lumbar and sacral plexus block with neurostimulation to plain bupivacaine spinal anesthesia and reported adequate anesthesia and no need for general anesthesia in either group.…”

Section: Discussionmentioning

confidence: 99%

Shamrock Lumbar Plexus Block for Hip Hemiarthroplasty in a High Risk Elderly Patient with Hip Fracture

Soulioti

Kavezou

Giannoulis

et al. 2022

J Long Term Eff Med Implants

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Hip fractures in the geriatric population are associated with high morbidity and mortality rate. Early surgical fixation is of major importance, as it is one of the factors that contribute to patient optimization. However, these patients usually present a high burden of comorbidities, including aortic stenosis that could affect their treatment. Despite major advances in anesthetic and surgical techniques, severe aortic stenosis remains an independent, important risk factor for patients undergoing anesthesia for noncardiac surgery. In these patients, general and/or neuraxial anesthesia should be avoided; peripheral nerve blockade is a viable option. This article presents a 96-year-old hip fracture patient with severe aortic stenosis and aspiration pneumonia that successfully underwent hip hemiarthroplasty under peripheral nerve blockade as sole anesthesia.

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“…[ 3 ] With the development of new techniques such as ultrasound and peripheral nerve stimulator, the scope of anesthesia has shifted from general anesthesia (GA) and central neuraxial blockade for isolated limb surgery to peripheral nerve blocks. [ 4 ] One of the most useful but most neglected anesthetic technique is the combination of sciatic and femoral nerve block (3:1) for lower limb surgery. [ 5 ] However, the maximum dose of a drug used should be kept in mind as large volumes are used in two blocks.…”

Section: Introductionmentioning

confidence: 99%

Lower limb surgeries under combined femoral and sciatic nerve block

2016

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Introduction:Peripheral nerve blocks are gaining popularity for many infraumblical surgeries with the development of new techniques such as ultrasound and peripheral nerve stimulator. It provides stable hemodynamic, better, and prolonged postoperative analgesia. This study was carried out to see the effectiveness of combined femoral and sciatic nerve block with ropivacaine alone and by adding fentanyl.Materials and Methods:The study was carried out on 100 patients scheduled for lower limb surgeries and were randomly divided into two groups of 50 each. In Group A, patients received 20 ml of 0.5% ropivacaine for femoral nerve block and same dose for sciatic nerve block and in Group B, 25 μg fentanyl was added each for femoral nerve and sciatic nerve block along with ropivacaine. All hemodynamic parameters, onset and duration of sensory and motor blocks were noted. The patient characteristics were analyzed using the “Chi-square tests” and the intergroup comparison of the parametric data was carried out using the unpaired t-test using software IBM SPSS 17.0.Results:Combined femoral and sciatic nerve block provide longer duration of postoperative analgesia of about 12–13 h. All the above-mentioned parameters were statistically non-significant.Conclusion:Hence in this study, onset and duration of sensory and motor block was comparable in both groups. However postoperative analgesia was prolonged as compared to neuraxial blockade without any hemodynamic instability.

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Combined psoas compartment and sciatic nerve block for lower limb surgery: An alternative anesthetic option in high-risk geriatric patients

Cited by 3 publications

References 1 publication

Orthopedic Surgeries of Lower Limb under Combined Femoral and Sciatic Nerve Block: A Comparative Study in RMCH & RC

Orthopedic Surgeries of Lower Limb under Combined Femoral and Sciatic Nerve Block: A Comparative Study in RMCH & RC

Shamrock Lumbar Plexus Block for Hip Hemiarthroplasty in a High Risk Elderly Patient with Hip Fracture

Lower limb surgeries under combined femoral and sciatic nerve block

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