Peripheral nerve blocks for perioperative management of patients having orthopedic surgery or trauma of the lower extremity

Abstract

Over the past decade several developments have lead to an increased interest in lower extremity PNBs including transient neurologic symptoms associated with spinal anesthesia, increased risk of epidural hematoma with the introduction of new antithromboembolic prophylaxis regimens, and evidence of improved rehabilitation outcome with continuous lower extremity PNBs. Simultaneously, the field of lower extremity blockade has been revolutionized through our better understanding of functional regional anesthesia anatomy, introduction of new drugs, better and more sophisticated equipment and wider teaching of lower extremity nerve block techniques. This review focuses on techniques and applications of lower extremity nerve blocks in patients having orthopedic surgery or trauma of the lower extremity, as well as potential complications and means to avoid them.

Ropivacaine versus Bupivacaine for 3-in-l Block during Total Knee Arthroplasty

“…24 The 3-in-1 block can cause several local complications (incomplete nerve blockade, direct nerve trauma with potential quadriceps wasting, local haematoma, ischaemic injury, and infection). 25 In 4 patients with a fall and further injury after a 3-in-1 block, the legs exhibited reduced 2-point discrimination, pain, and/or light touch sensation, and full weight bearing was delayed. 26 Therefore, patients having a 3-in-1 block should be examined postoperatively to ensure full motor recovery, proper proprioceptive function, and normal neurologic behaviour before mobilisation.…”

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review

“…Complications such as urinary retention, arterial hypotension, and motor block are quite common. Problems related to epidural catheters must also be considered when choosing an analgesic regimen, for example, the challenging management of anticoagulants as prophylaxis for deep vein thrombosis, and the possibility of the failure of a central neuraxial block (16). The absence of such limitations with the 3-in-1 block highlights the importance of having this technique in our therapeutic armoire.…”

Postoperative Fall after the Use of the 3-in-1 Femoral Nerve Block for Knee Surgery: A Report of Four Cases

“…10 The common complications of FNB include incomplete nerve blockade, direct nerve trauma with potential quadriceps wasting, local haematoma and subsequent ischaemic injury, infection, and the risks of systemic intravenous injection of the local anaesthetic agent. 11 We present a serious postoperative complication related to the use of FNB in 4 patients, each of whom fell and sustained further injury.…”