Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Feb 15:6:9-12.
doi: 10.2147/LRA.S37261. Print 2013.

A new, lateral, continuous, combined, femoral-sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

Luiz Eduardo Imbelloni  1 , Carlos Rava, Marildo A Gouveia
Affiliations
Case Reports

A new, lateral, continuous, combined, femoral-sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

Luiz Eduardo Imbelloni et al. Local Reg Anesth. .

Abstract

Background: The prevalence of anterior knee pain following intramedullary tibial nail insertion is high. Continuous peripheral nerve blockade is an alternative method of pain control to opiods. This case illustrates the use of femoral nerve and sciatic nerve peripheral catheters with an elastomeric infusion pump for major intramedullary nailing surgery.

Case report: A 36-year-old male with fractures to the left leg bones presented for placement of an intramedullary nail under spinal anesthesia. At the end of the procedure, access to the lateral femoral and sciatic continuous nerve block was achieved by using a stimulator connected to a 110 mm 18G Tuohy needle. Postoperative analgesia was provided with a 40-hour infusion of 0.1% bupivacaine (400 mL) at a rate of 10 mL hour(-1) with an elastomeric pump. Anesthetic dispersion and contrast were investigated. The analog scale remained with scores below 3 during the 40 hours after surgery, and boluses were not necessary.

Conclusion: The use of a femoral and sciatic nerve peripheral catheter offered an alternative to conventional pain control. Continuous femoral-sciatic peripheral blockade via a skin puncture with an infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.

Keywords: bupivacaine; continuous peripheral nerve block; elastomeric pump; local anesthetic; orthopedic surgery; tibia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Diagram for insertion of the needle.
Figure 2
Figure 2
The spread of contrast in combined continuous femoral and sciatic nerve block. Notes: 1 is the spread of contrast in the continuous femoral nerve block; 2 is the spread of contrast in the continuous sciatic nerve block.
See this image and copyright information in PMC

References

    1. Court-Brown CM, Will E, Christie J, McQueen MM. Reamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures. J Bone Joint Surg. 1992;74-B:770–774. - PubMed
    1. Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nailinsertion techniques. J Bone Joint Surg Am. 2002;84-A:580–585. - PubMed
    1. Karachalios T, Babis G, Tsarouchas H, et al. The clinical performance of a smaller diameter tibial nailing system with a mechanical distal aiming device. Injury. 2003;31:451–459. - PubMed
    1. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006;88-B:576–580. - PubMed
    1. Imbelloni LE. A new lateral combined femoral-sciatic nerve approach via a single skin puncture (Letter to Editor) J Pain Relief. 2012;1:102.

Publication types

LinkOut - more resources