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ESRA19-0031 Ultrasound-guided combination of 3 peripheral nerve blocks in an emergency patient with fractured shin bone
  1. L Sakic1,
  2. I Brkic2,
  3. N Starcevic3,
  4. K Semanjski4 and
  5. K Sakic5
  1. 1University Hospital Sveti Duh, Anaesthesiology, Reanimatology and Intensive Medicine, Zagreb, Croatia
  2. 2University Hospital Sveti Duh, Anaesthesiology, Reanimatology and Intensive Medicine, Zagreb, Croatia
  3. 3University Hospital Sveti Duh, Surgery, Division of Orthopaedic Surgery, Zagreb, Croatia
  4. 4University Hospital Sveti Duh, Surgery, Division of Abdominal Surgery, Zagreb, Croatia
  5. 5Maxillofacial, General and Plastic Surgery Polyclinic ‘Bagatin’, Department of Anaesthesiology and Pain Therapy, Zagreb, Croatia


Background and aims Emergency patient with fractured left shin bone ASA status 3 was enrolled for emergency osteosynthesis. The patient ate 2 hours before acceptance and received 10 mg metoclopramide and 50 mg ranitidine intravenously. Cardiac murmur 4/6 was found during physical examination over praecordium of which the patient had no knowledge. Other known comorbidities were hypertension, hypothyreosis and overweight. Due to unspecified cardiac murmur and the notion patient ate before the accident we excluded spinal anaesthesia as an option.

Methods We successfully performed a combination of ultrasound-guided femoral, distal sciatic and saphenous block using in-plane technique. Time from the performed blocks to the start of surgical procedure was half an hour. We used propofol via TCI pump for light sedation during the surgical reposition.

Results Patient was stable the whole time during the procedure with stable blood pressure and pulse, breathing spontaneously with SpO2 100% via oxygen facial mask 4 l/min. Intraoperative blood loss was about 150 ml.

Conclusions The blocks were successful, and no block-related complications were noted. No opioid requirements after surgery were noted in postoperative period as well. Ultrasound-guided peripheral nerve blocks are a good option of anaesthesia and analgesia for emergency patients.

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