The use of ultrasound guided combined peripheral nerve blocks in a high-risk patient: A case report

Combined peripheral nerve blocks can be used as an alternative anesthetic technique for lower limb amputations in high-risk patients. The approach may vary according to the clinical condition of the patient. Presently described is the use of a combination of peripheral nerve blocks used for above-the-knee amputation in a high-risk patient: a sciatic nerve block with an anterior approach, a femoral nerve block, and a lateral femoral cutaneous nerve block.

Yüksek riskli hastada ultrason rehberliğinde kombine periferik sinir bloğu: Olgu sunumu

Kombine periferik sinir blokları, yüksek riskli hastalarda alt ekstremite ampütasyonları için alternatif bir anestezi tekniği olarak kullanılabilir. Hastanın klinik durumuna bağlı olarak blok uygulamaları için farklı yaklaşımlar tercih edilebilmektedir. Bu olgu sunumunda, yüksek riskli bir hastada diz üstü amputasyonu sırasında anterior yaklaşım ile siyatik sinir bloğu, femoral sinir bloğu ve lateral femoral kutanöz sinir bloklarından oluşan periferik sinir bloğu kombinasyonunun kullanımı bildirilmektedir.

Kaynakça

1. Kocum A, Turkoz A, Bozdogan N, Caliskan E, Eker EH, Arslan G. Femoral and sciatic nerve block with 0.25% bupivacaine for surgical management of diabetic foot syndrome: an anesthetic technique for high-risk patients with diabetic nephropathy. J Clin Anesth 2010;22(5):363–6.

2. Ota J, Sakura S, Hara K, Saito Y. Ultrasound-guided anterior approach to sciatic nerve block: a comparison with the posterior approach. Anesth Analg 2009;108(2):660–5.

3. Beck GP. Anterior approach to sciatic nerve block. Anesthesiology 1963;24:222–4.

4. Komasawa N, Watanabe N, Sakai M, Minami T. A novel skin traction method to facilitate ultrasound-guided femoral nerve block in morbidly obese patients. J Clin Anesth 2017;39:3.

5. Tsui BC, Ozelsel TJ. Ultrasound-guided anterior sciatic nerve block using a longitudinal approach: “expanding the view”. Reg Anesth Pain Med 2008;33(3):275–6.

6. Karm MH, Lee S, Yoon SH, Lee S, Koh W. A case report: the use of ultrasound guided peripheral nerve block during above knee amputation in a severely cardiovascular compromised patient who required continuous anticoagulation. Medicine (Baltimore) 2018;97(9):e9374.

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