Une méthode antérieure combinée utilisant un seul site d’injection cutanée permet l’anesthésie des membres inférieurs chez des patients en décubitus dorsal

Abstract

P Pu ur rp po os se e: : Lower limb anesthesia (LLA) requires the combination of, at least, three-in-one and sciatic nerve (SCN) blocks. Anterior approaches are easier to perform with minimal discomfort in supine patients, specially for traumatology. Feasibility of a single needle entry combined approach is reported.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : The combined landmark was applied in 119 ASA I and II patients (32-68 yr) scheduled for surgery below the knee. Needle (nerve stimulation applied through a single 150-mm long b-bevelled insulated needle) was inserted at the midpoint between the two classical approaches. Thirty and 15 mL of 0.5% ropivacaine were injected close to the femoral and the SCN, respectively. During the following 45 min, the extent of sensory block and knee and ankle motor block were assessed.

The Effects of Alkalinization of 0.5% Ropivacaine by Adding Sodium Bicarbonate on Block Onset, Ending Time and Quality, and Postoperative Analgesic Efficiency for Peripheral Nerve Block in Unilateral Extremity Surgery

“…In terms of motor block ending times, no difference was observed at hours 1, 2 or 4, although a significantly prolonged motor block time was observed in the alkalinized group at hours 6 and 12. This difference disappeared at 24 h. Mean motor block ending times were 12.54 h and 18.96 h in our groups and were similar to those reported by Pandin et al 8 The latest block ending times were hours 22 and 24, respectively. Our results suggest that alkalinization does not have unwanted consequences such as motor blocks over 24 h.…”

“…Motor block was evaluated using the Bromage Scale (BS) (0: no motor block, 1: hip flexion normal but weak knee and ankle movements, 2: weak hip and knee movements, normal ankle movement, 3: weak hip, knee and ankle movements). 8 In the BS test, 2 and 3 are regarded as sufficient values. Cases determined as sufficient in terms of sensorimotor block were operated on at the end of 30 min.…”

Evaluation of the Effectiveness of Anterior Combined Approach of 3 in 1 Block and Sciatic Nerve Block by Single Injection Technique for Below Knee Procedures

“…A new single position supine approach to sciatic and femoral nerve block was described by Raj et al 11 However the lithotomy position which they described was difficult to be achieved in patients with limited mobility. Pierre Pandin et al 12 proposed the single injection technique for the combined 3 in 1 block and sciatic nerve block. From the needle injection point described, the needle was directed caudad and laterally to perform the sciatic nerve block; and then directed cephalad and medially to locate the femoral nerve.…”

Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty

“…In a metaanalysis of eight randomized controlled trials including 379 patients, it was reported that the addition of sciatic nerve block to femoral nerve block in TKA significantly reduces postoperative pain and opioid consumption 11,12 . USG guided anterior sciatic nerve block in addition to femoral nerve block can be safely applied in arthroscopic knee surgeries, knee surgeries, and in patients with high comorbidity, the application of other anesthesia methods is at high risk, and it has also been reported that this block provides effective postoperative analgesia [13][14][15] . In our study, we preferred the anterior sciatic nerve block owing to its ease of administration and better tolerability by patients, and this block does not require a special position, unlike other sciatic nerve block approaches.…”