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 We describe Surgery Specific Regional Anaesthesia(SSpecRA), as the term/concept in which according to the diagnosis and planned surgery, a regional anaesthetic technique is planned for surgical anaesthesia comforting the patient and reducing the risk associated with blocking unwanted structures, on one hand reducing complications and on the other hand preventing conversion to general anaesthesia in high risk patients. The nerves to be blocked for a particular surgery should be analysed and tailored for surgery to be done exclusively under regional anaesthesia with respect to the steps involved in the surgery, nerve supply to the skin, bony, capsular, muscular components and usage of tourniquet. Position during the surgery and discomfort from other injuries also to be considered.

Methods A 60y old male with post traumatic, un-displaced Odontoid(C2) fracture without any neurological deficit, was posted for Closed Reduction Intramedullary Nailing of Tibia under tourniquet. Under USG guidance Right Femoral(25ml of LA mixture), Sciatic(30ml of LA mixture)was administered. LA mixture- 22.5ml of 2%Lignocaine with Adrenaline(5mcg/ml), 22.5ml of 0.5%Bupivacaine, 5ml of Sodabicarbonate7.5%, 3ml of Normal saline and 2ml of 8mg Dexamethasone. USG Obturator Nerve block(anterior branch(7ml) and posterior branch(3ml) of 0.2% Ropivacaine) was blocked for tourniquet at thigh. Safe Local Anaesthetic dosage, volume and concentration for surgical anaesthesia was considered.

Results Intraoperatively patient was comfortable and surgery was uneventful without conversion to general anaesthesia. Total duration of anaesthesia analgesia was around 7h.

Conclusions USG guided Femoral, Sciatic and Obturator Nerve block can be considered as a sole Surgery Specific Regional Anaesthesia(SSpecRA) for intramedullary tibial nailing under tourniquet.