Echo-Guided Differential Popliteal Block in an Obese Patient With Intractable Painful Leg Ulcer for Early Discharge in Day Surgery

Abstract

Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain. Our aim was to ensure an optimal degree of analgesia and, at the same time, to save motor function in order to make early discharge possible. We used 15 mL ropivacaine 0.375% to obtain a differential block, taking advantage of sensitive fibers selectivity of ropivacaine. Surgical debridement was performed successfully. Our peripheral blockade was able to provide significantly prolonged analgesia without motor block that guaranteed a safe and early discharge according to the Post Anesthetic Discharge Scoring System. The satisfaction expressed by the patient and her comfort during the procedure support the choice of this approach for intractable painful ulcers of lower limb.

Ultrasound: The Magic Wand for Wound Healers

“…Ultrasound is a very useful modality for the diagnosis and management of arterial, venous, and other lower extremity wounds. 1,2 Experience with this modality is now huge, and it is still accumulating. Indeed, treatment of wounds and musculoskeletal pain are some of its new implications.…”