Sciatic obturator femoral technique versus spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. A randomised trial

Moktan

Kathmandu Univ. Med. J.

2020

Background Sciatic nerve block used for various surgeries below knee and for maintenance of analgesia demonstrates wide variability regarding its bifurcation into tibial and common peroneal nerves, frequently accounting for incomplete nerve blocks. Objective To determine the variation of sciatic nerve bifurcation among Nepalese volunteers. Method This cross sectional study was conducted in the Department of Anesthesiology of Kathmandu Medical College Teaching Hospital from March to May 2019, where 110 healthy volunteers underwent ultrasonography of sciatic nerve starting from popliteal fossa to its bifurcation. The distance between the bifurcation of sciatic nerve from popliteal crease and depth of the nerve at that point from the skin were measured. Result The mean distance at which sciatic nerve bifurcated from the popliteal crease was 5.42 ± 1.37 cm. Most commonly, the sciatic nerve bifurcated at a distance of 5-7 cm from the popliteal crease in 110 limbs (50.45%). However, in 80 limbs (36.69%), the bifurcation was found at less than 5 cm from the popliteal crease. The depth of the nerve from the skin at the point of bifurcation was 1.72 ± 0.54 cm, with results showing it was deeper in females compared to males (p value < 0.001). Conclusion This study showed that though the distance of sciatic nerve bifurcation from the popliteal crease in our study group was coherent with the published literature of 5-12 cm; many volunteers also had this bifurcation at distances less than 5 cm. Females showed nerves to be deeper at the point of bifurcation than males.

Section: Figure 1 Ultrasound Anatomy Of the Sciatic Nerve At Its Bifmentioning

confidence: 99%

Ultrasonographic Assessment of the Distance of Sciatic Nerve Bifurcation from the Popliteal Crease and its Depth from Skin in Volunteers

Moktan

Kathmandu Univ. Med. J.

2020

Computational and Mathematical Methods in Medicine

“…The previous nerve blocks were all difficult to operate, and they all located the target nerve by blind detection, which could not confirm the diffusion range of anesthesia and could not guarantee the effect of the block. Even if the anesthesiologist has rich experience, there will be anatomical variations, individual differences, and other factors that may lead to inaccurate injection of anesthesia drugs and poor nerve block results [ 7 , 8 ]. With the continuous development of medical technology, ultrasound-guided nerve block technology has been widely used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of Ultrasound Image-Guided Nerve Block on the Postoperative Recovery Quality of Patients with Tibial Fractures Using the Concept of Enhanced Recovery after Surgery

Zhang

Hé

et al. 2022

This study was aimed at investigating the clinical effect of ultrasound-guided nerve block based on the concept of enhanced recovery after surgery (ERAS) for postoperative anesthesia in patients with tibial fractures. The noise-reduction processing was introduced in ultrasound images to adjust the ultrasound clarity of the patient. A total of 177 patients with tibial fractures in our hospital were retrospectively analyzed and divided into OG group (general anesthesia combined with nerve block, 78 cases), C1 group (simple general anesthesia, 27 cases), C2 group (ultrasound-guided nerve block combined with general anesthesia, 10 cases), and C3 group (62 cases of spinal-epidural anesthesia). The effect of anesthesia and postoperative recovery time of patients in each group were analyzed. The wake-up time of the OG group was significantly shorter than that of the other three groups ( P < 0.05 ). The doses of propofol and remifentanil in the OG group were much lower than those in the other groups ( P < 0.05 ). After the ultrasound image was processed with noise reduction, the image showed the lesion more clearly. The excellent and good rates of OG group, C1 group, C2 group, and C3 group were 89.86%, 62.73%, 75.37%, and 61.07%, respectively. The Ramsay sedation score and anesthesia satisfaction in the OG group were obviously higher than those in the other groups, but there was no significant difference ( P > 0.05 ). The visual analogue scale (VAS) scores of the OG group at 12 h, 24 h, and 36 h after the surgery were 4.52 ± 0.41 , 4.72 ± 0.24 , and 4.81 ± 0.74 , respectively, which were significantly higher than those of the other three groups ( P < 0.05 ). On the basis of ERAS, ultrasound-guided nerve block combined with general anesthesia can improve the perioperative pain in patients with tibial fractures and significantly shorten the time for the wake-up time. In addition, it was safe and reliable, so it was worthy of clinical promotion.

SIMBA—A Single-Puncture Approach to Lower Limb Block

Prasad,

Jain

2024

A&A Practice

Peripheral nerve blocks provide a safe and reliable alternative in the anesthetic management of femur fractures in elderly subpopulations associated with significant comorbidities. Single-Insertion Multiple Nerve Block Anesthesia (SIMBA) is a technique where a single needle insertion is used to block all four nerves that supply the femur shaft: the femoral nerve, obturator nerve, lateral femoral cutaneous nerve, and sciatic nerve. The authors performed this technique in 11 cardiac compromised geriatric patients with midshaft/distal femur fractures, and the surgery was conducted successfully without any significant hemodynamic change and good postoperative analgesia.