Article Text
PDF
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims Peripheral nerve blocks can be a valuable option for managing anesthesia and pain in patients with complicated distal leg fractures in the setting of polytrauma. Performing bilateral peripheral nerve blocks in an anorexic patient undergoing lower leg surgery may present some challenges. The patient‘s overall health status has to be carefully assessed, including any complications related to anorexia nervosa, such as electrolyte imbalances, cardiac issues, or compromised organ function. Sacral plexus injuries are relatively uncommon and can occur due to trauma, such as pelvic fractures.
Methods 28 years old polytraumatised female patient, BMI 13.7, was scheduled for a right lower leg fracture and left calcaneus surgery. The osteosynthesis of the tibia and fibula was performed in the popliteal with a saphenous nerve block and was followed by calcaneus surgery in the ankle block. The total amount of local anesthetic applied was higher than proposed for the weight, ankle block being performed 4 hours after the popliteal with saphenous block. The total amount of 0.5% levobupivacain for the procedure was 200 mg. The duration of surgery was 7.5 hours, the estimated blood loss was 900 ml, and the patient was sedated with target controlled infusion of propofol.
Results Peripheral nerve blocks decreased the necessity for postoperative opioids. Electromyoneurography conducted two weeks after the surgery showed no variance from the preoperative findings.
Conclusions The decision to perform bilateral nerve blocks should be made on a case-by-case basis, considering the risks and benefits for the individual patient.
Intraoperative X-ray of the right lower leg
Intraoperative X-ray of the left calcaneus