Combined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis

Chen, Lingmin; Liu, Jin; Yang, Jing; Zhang, Yanzi; Liu, Yue

doi:10.1097/aap.0000000000000350

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…However, due to the lack of reliable sensory block in dermatome T12 and L1 [25], a combination of lumbar plexus and sacral plexus block failed to provide consistent surgical anesthesia for hip surgery [6, 8, 26, 27]. Several techniques have been introduced to overcome the limitation, such as large dosage of propofol and opioids [8], infiltration at incision [4] and iliac crest point block [9]. However, these techniques were unreliable, and conversion to general anesthesia was required occasionally.…”

Section: Discussionmentioning

confidence: 99%

“…Because of ossification of the ligament and deformity of the lumbar spine, success rate of epidural and spinal anesthesia reported in patients with ankylosing spondylitis was very low [3]. Several studies have reported combination of lumbar plexus and parasacral plexus for hip surgeries [4–8]. In these studies, however, either large dose of propofol, iliac crest block [9] or infiltration to the incision [4] was needed.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported combination of lumbar plexus and parasacral plexus for hip surgeries [4–8]. In these studies, however, either large dose of propofol, iliac crest block [9] or infiltration to the incision [4] was needed. We report here with a novel combination of lumbar plexus block, sacral plexus block and T12 paravertebral block successfully used for total hip arthroplasty for 4 patients with severe ankylosing spondylitis without any opioids and intravenous propofol.…”

Section: Introductionmentioning

confidence: 99%

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Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

Liu

et al. 2017

BMC Anesthesiol

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BackgroundAnesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block.Case presentationFour patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations.ConclusionsThe combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

Liu

et al. 2017

BMC Anesthesiol

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“…"Hourglass-sign" combined with sacral plexus block can theoretically meet the criteria of closed reduction and internal fixation for femoral neck fractures. Several studies have reported that ultrasound-guided nerve block anesthesia had been successfully applied in hip surgery [10], but the safety and effectiveness of lumbar plexus block and fascia iliac block for old patients in the clinic are still controversial [11,12]. At present, there is no relevant report on the combination of "hourglass-sign" and sacral plexus block in elderly patients with femoral neck fracture undergoing closed reduction and internal fixation for femoral neck fractures.…”

Section: Introductionmentioning

confidence: 99%

Feasibility Of “Hourglass-Pattern” Fascia Iliac Combined With Sacral Plexus Block In Elderly Femoral Neck Fractured Patients Undergoing Closed Reduction And Internal Fixation For Femoral Neck Fractures: A Prospective Observational Study

Huang²,

Wang³

2021

OAJBS

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Background: To evaluate the feasibility of "hourglass-sign" fascia iliac block and sacral plexus block for elderly femoral neck fractured patients with multiple complications.Methods: A total of 32 patients with femoral neck fracture undergoing closed reduction and internal fixation for femoral neck fractures were included. Ultrasound-guided "hourglass-sign" fascia iliac block and sacral plexus block anesthesia were applied to all patients. The success rate of anesthesia, the hemodynamic parameters, VAS scores, general clinical data and perioperative information would be collected.Results: 30 patients were included and analyzed into the study finally, all patients were diagnosed with different systemic diseases before surgery. The successful rate of "hourglass-sign" fascia iliac block combined with sacral plexus block guided by ultrasound and nerve stimulator was 93.8%. The change of MAP at different time points was about 5% of the baseline values, and the heart rate was about 7%. VAS scores decreased significantly after anesthesia and continued at least 1 hour after surgery. The anesthesia evaluation degree of most patients was satisfactory. There were no complications or adverse reactions associated with anesthesia. Conclusion:This combined nerve block provided effective anesthesia for closed reduction and internal fixation for femoral neck fractures of elderly patients, rarely caused instability in the circulatory system, had fewer adverse reactions and could be widely used in clinical practice.Trial Registry: This trial was registered at Chinese clinical trial (ChiCTR2000034114)

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“…However, because of the high risk of morbidity and mortality in AS patients, the world's major medical scientists have been seeking active treatments (17). After treatment, there is a chance of cardiovascular and respiratory complications in AS patients (18,19).…”

Section: Introductionmentioning

confidence: 99%

Potential regulatory factors in the pathogenesis of ankylosing spondylitis

Hong-xi

Zhou

et al. 2020

Cell Mol Biol (Noisy-le-grand)

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Ankylosing spondylitis (AS) is a chronic rheumatic disease that mainly affects the spinal joints (vertebrae). Spondylitis means inflammation of the spine, and ankylosing spondylitis means that bones tend to fuse. The AS causes the vertebrae to swell in the spine. Therefore, based on protein interaction network analysis, we conducted in-depth research on the molecular mechanism of key regulatory factors in the AS disease process. We carried out a differential analysis of the expression of miRNAs in disease samples and miRNAs in normal samples. Protein network interaction analysis is performed according to a group of target genes regulated by significant differentially expressed miRNAs and clustered into an interaction module. In addition, enrichment analysis of functions and pathways was performed on these modular genes. Based on the predictive analysis of multidimensional regulators, we identified a range of regulatory factors that have potential regulatory effects on AS, such as endogenous genes and transcription factors. We obtained 20 differentially expressed miRNAs and 7082 target genes and clustered into 11 modules. Enrichment results showed that these modular genes are mainly involved in the functions and pathways of protein polyubiquitination, neutrophil activation involved in immune response, and Wnt signaling pathway. We revealed ten transcription factors (MYC, NFKB1, and TP53). After network connectivity analysis, we obtained 12 internal drive genes (UBE2D1, CCNF, and NEDD4). These core genes are thought to be potential regulators of AS.MYC is also considered to be a core factor that inhibits SART3 phosphorylation and plays a vital role in the immunological pathogenesis of AS. The combination of the above analysis results can provide a new idea for biologists and medical scientists to study the immune pathogenesis of AS and can provide a valuable reference for subsequent treatment options.

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Combined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis

Cited by 6 publications

References 31 publications

Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

Feasibility Of “Hourglass-Pattern” Fascia Iliac Combined With Sacral Plexus Block In Elderly Femoral Neck Fractured Patients Undergoing Closed Reduction And Internal Fixation For Femoral Neck Fractures: A Prospective Observational Study

Potential regulatory factors in the pathogenesis of ankylosing spondylitis

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