[Regional anesthesia and neurological diseases]

Postoperative sciatic and femoral or saphenous nerve blockade for lower extremity surgery in anesthetized adults

Background:

Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery.

Materials and Methods:

Postoperative patients administered general anesthesia received popliteal sciatic nerve blockade and either femoral or saphenous nerve blockade if operative procedures included medial incisions. Nerve blocks were placed with nerve stimulator or ultrasound guidance. A continuous nerve catheter was inserted if hospital admission was over 24 hours. Opioid analgesic supplementation was administered for inadequate pain relief. Postoperative pain scores and total analgesic requirements for 24 hours were recorded. Nerve block related complications were monitored for during the hospital admission and at follow up surgical clinic evaluation.

Results:

190 anesthetized adult patients were administered 357 nerve blocks. No major nerve injury or deficit was reported. One patient had numbness in the toes not ascribed to a specific nerve of the lower extremity. Perioperative opioid dose differences were noted between male and female and between opioid naïve and tolerant patients.

Spinalanästhesie

Bei der Spinalanästhesie (SPA) wird ein Lokalanästhetikum in den lumbalen Subarachnoidalraum (Spinalkanal) injiziert. Das Lokalanästhetikum unterbricht die Nervenleitung und es entsteht eine reversible sensorische, motorische und sympathische Blockade. Je nach Ausdehnung der blockierten Körperregionen können Operationen an den unteren Extremitäten, im Becken, am Perineum und im Unterbauch sowie geburtshilfliche Eingriffe wie z. B. die Sectio caesarea durchgeführt werden. Wichtigste und häufigste Nebenwirkung der SPA ist der Blutdruckabfall durch die Sympathikusblockade. Weitere (seltene) Komplikationen sind Bradykardie/Asystolie, totale Spinalanästhesie, postspinale Kopfschmerzen, Hörverlust, spinale Hämatome und Nervenschäden. Systemisch-toxische Wirkungen durch das Lokalanästhetikum sind in der Regel nicht zu erwarten.