“…A 22-gauge, 50mm echogenic needle is advanced in an in-plane, lateral-to-medial orientation to separately block the SN and PFCN. 12–14 , 17 Figure 3 Subgluteal approach of Sciatic Nerve and Posterior Femoral Cutaneous Nerve at gluteal crease. ( a ) Probe position and landmarks.…”
Section: Anesthesia Techniquementioning
confidence: 99%
“…A 22-gauge, 50mm echogenic needle is advanced in an in-plane, lateral-to-medial orientation to separately block the SN and PFCN. [12][13][14]17 While both subgluteal and transgluteal approaches are accepted, the transgluteal approach was exclusively used for all patients in this case series, reflecting practitioner preference rather than a prescriptive standard.…”
Section: Subgluteal Approach To the Sciatic Nerve And Posterior Femor...mentioning
Purpose
The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique—sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks —in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.
Patients and Methods
Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.
Results
The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.
Conclusion
The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.
“…A 22-gauge, 50mm echogenic needle is advanced in an in-plane, lateral-to-medial orientation to separately block the SN and PFCN. 12–14 , 17 Figure 3 Subgluteal approach of Sciatic Nerve and Posterior Femoral Cutaneous Nerve at gluteal crease. ( a ) Probe position and landmarks.…”
Section: Anesthesia Techniquementioning
confidence: 99%
“…A 22-gauge, 50mm echogenic needle is advanced in an in-plane, lateral-to-medial orientation to separately block the SN and PFCN. [12][13][14]17 While both subgluteal and transgluteal approaches are accepted, the transgluteal approach was exclusively used for all patients in this case series, reflecting practitioner preference rather than a prescriptive standard.…”
Section: Subgluteal Approach To the Sciatic Nerve And Posterior Femor...mentioning
Purpose
The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique—sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks —in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.
Patients and Methods
Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.
Results
The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.
Conclusion
The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.
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