98. Pheral nerve blocks forostheosynthesis of pertrochanteric femurfracture

Vieta, C, Domingo T, Mayoral V, Koo M,Viscosillas, Montero Acristinavieta@yahoo.esDepartment of Anesthesiology. Hospital Universitari deBellvitge. Barcelona, Spain Feixa Llarga s/n 08907L’Hospitalet de Llobregat, Barcelona, Spain Taxdirt n° 1-3-5 08025 Barcelona Josep Tarradellas n° 17 08232Viladecavalls, Barcelona, Spain

Introduction: Osteosynthesis of pertrochanteric femur fracture isthe most common procedure on orthopedic emergency surgery onaged patients. It usually consists on fracture reduction and 135°plate-screw fixation. Spinal block is the most used anesthetic tech-nique. We propose as an alternative a femoral and a femorocuta-neous block combined with a parasacral block of the sciatic nerve(Mansour). Femoral, sciatic and obturator nerve innervate thefemoral diaphysis. The inferior gluteal nerve is related to sensitivityon the trochanteric massif. Femorocutaneous nerve gives sensitiveinnervation to the incision zone except to the most proximal inci-sion part (Iliohypogastric nerve or subcostal nerve).

Patients and methods: Twenty-three patients (5 Male, 18 Fe-male) undergoing surgery for pertrochanteric fracture were in-cluded. The rang of age varied between 53 and 92 years. ASAclasification status � 3 were 17. All patients were administered ironsacharate intravenously (Venofer®) dosage: 200 mgr/48h. Usualintraoperative monitoring was NIBP, ECG and pulse oxymetry.Oxygen therapy by nasal prongs. Firstly, we proceeded with thefemoral block using Winnie’s technique. After a motor response ofpatella movement at 0.5 mA (2 Hz), we administered 15 mL of0.5% ropivacaine. We performed the femorocutaneous nerve block(5 mL of 0.5% ropivacaine). After placing the patient in a lateraldecubitus position we performed a sciatic nerve block using aMansour’s technique. After obtaining a distal response and a neg-ative aspiration test, we injected 20 mL of 1.5% mepivacaine. Toreduce sedation dosage, we proceeded to block the contralateralobturator nerve (inguinal approach) with 50 mm neurostimulationneedle (5 mL of 1% mepivacaine). Propofol 0.1 - 0.2 mg/kg/h wasused to ensure confort to the patient. Recovery room: paracetamol1g/8 h IV and methamizol 2 g/8 h IV was administered.

Results: In all cases we obtained an excellent hemodynamic sta-bility (there were not more than 30 mm Hg decrease on meanblood pressure). There was no anesthetic technique failure and nosigns of local anesthetics toxicity were reported. VAS scores were 0at the recovery room and during the next 24 hours after surgery.

Conclusion: Unilateral and peripheral block of the low extremitygives a great haemodynamic. Mansour’s parasacral block allowsblocking both sciatic and inferior gluteal nerves and frequently theobturator nerve, too (all cases presented sensitive block). Thiscombination permits an acceptable dose of local anesthetic givinglong standing postoperative analgesia.

106. Novel approach for sciatic nerveblock: clinical study

Alpaslan Apan, Filiz Sari, Aysun Uz, Saziye Sahinalpaslanapan@doctor.comKirikkale University Faculty of Medicine Dep. ofAnaesthesiology*, Ankara University Faculty of MedicineDep. of Anatomy®, Saglik Cad. 71100 Kirikkale, TurkeyUrankent THK Bloklari E-2 Blok No: 15 DemetevlerAnkara, Turkey

Background and Goal of study: The classical approach to sciaticnerve (SN) block is not useful in patients with limited hip flexion(1). We aimed to assess the clinical effectiveness of surface land-marks obtained from previous anatomic study (2).

Materials and methods: The study was conducted in 50 healthyinformed adult patients undergoing lower extremity surgery, afterapproved from local ethics committee. Patients were randomlyassigned into two equal groups and sciatic nerve blocks were per-formed using Labat’s technique (Group L) or novel approach(Group N). To define novel technique, a line was drawn betweenposterior superior iliac spine (PSIS) to ischial tuberose (IT) and 8 cmfrom PSIS (A) and 2 cm lateral to IT (B) were marked. A slightlyconcave line from A to B was considered surface projections ofsciatic nerve and 5 cm from A was considered as needle insertionpoint (C). The stimulating needle was inserted perpendicularly tothe operating table. Ropivacaine 7.5% 20 ml solution was admin-istered with gentle aspirations after ankle dorsiflexion or eversionwas observed under 0.5 mAmp stimuli. The quality of block wasdetermined as good (no supplemental anaesthetic was required),satisfactory (IV or local supplementation was required) and failed(necessity of general anaesthesia).

Results and discussion: There was no difference between num-ber of attempt to find out sciatic nerve (Group L: 1.68 � 0.71,Group N: 1.57 � 0.59, p� 0.487). Also, there was no significantdifference between success rates (Group L: 13 / 10 / 2, Group N: 17/ 7 / 1 for good, satisfactory and failed cases, respectively).

Conclusion: This study suggests new and alternative landmarksfor determining the surface projections of sciatic nerve in a linerather than describing points for needle insertion. The alternativeapproach that determined in this study provides flexibility to theanaesthetist and seems to be reliable especially in patients in limitedpositioning.

References:1. van Staa TP, et al. Bone 2001; 29: 517-22. 2. Apan A, et al. EJA 21, Supp 32:

A-452.

Key Words: Regional anaesthesia, nerve block, sciatic nerve.

Posters • Peripheral Nerve Blocks 57