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  • #35774 Early discharge after lower leg surgery in popliteal and saphenous nerve block in a 95-years old patient with a recent stroke – A case report

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Peripheral nerve blocks
#35774 Early discharge after lower leg surgery in popliteal and saphenous nerve block in a 95-years old patient with a recent stroke – A case report
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  1. Mirela Dobrić1,
  2. Agata Škunca1,
  3. Goran Sabo2 and
  4. Dejan Blažević3
  1. 1Department of Anesthesiology, Pain Management and Intensive Medicine, Traumatology Clinic, , Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia
  2. 2Department Anesthesiology, Pain Management and Intensive Medicine, Traumatolology Clinic, Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia
  3. 3Sports Medicine, Clinical Hospital Center Sestre milosrdnice, Traumatology Clinic, Zagreb, Croatia

Abstract

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Background and Aims The number of elderly patients presenting for trauma surgery is increasing with the aging population. The perioperative management of the elderly is often complicated by coexisting diseases and polypharmacy which may delay surgical treatment due to preoperative optimization. The anesthetic technique should be guided by the intended surgical procedure, patient preference and comorbidity. Frail elderly patients are at increased risk for postoperative complications, cognitive impairment, and longer hospital stays.

Methods A 95-years old female had unstable fracture after external fixation of tibia and fibula, due to trans calcaneal pin instability. She was scheduled for replacement of external delta frame fixator with supracutenous locking plate but had an ischemic stroke six days after the first surgery. Six weeks after the stroke and partial recovery of left-sided hemiparesis, the extraction of delta frame and supracutenous plate fixation has been performed in ultrasound-guided popliteal nerve block combined with a saphenous nerve block, with 0.75% ropivacaine.

Abstract #35774 Figure 1
Abstract #35774 Figure 1

Delta frame, external fixation, on right lower leg.

Abstract #35774 Figure 2
Abstract #35774 Figure 2

Radiograph of right lower leg with supracutaneous plate

Abstract #35774 Figure 3
Abstract #35774 Figure 3

Supracutenous plate on right lower leg

Results A small dose of ketamine, 15 milligrams, was administered during the surgical procedure in the peripheral nerve block as the patient indicated slight pain at the skin incision. Neither extra sedation nor analgesics were required during the surgery nor for ten hours following. The patient was pleased with the painless treatment and showed no signs of cognitive impairment, enabling safe discharge the following day. The patient is routinely going to surgical check-ups six months following the surgery.

Conclusions Peripheral nerve block should be considered where feasible in the primary approach to anesthesia and analgesia in the elderly patient.

  • supracutenous plate
  • popliteal nerve block
  • saphenous nerve block

http://dx.doi.org/10.1136/rapm-2023-ESRA.504

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