Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series

Journal of Medical Case Reports

Case Report

Antonio Coviello¹  Annachiara Marra¹  Maria Vargas¹  Pasquale Diglio¹  Dario Cirillo¹  Giuseppe Servillo¹  Carmine Iacovazzo¹  Andrea Cozzolino²  Antonio Izzo²  Alessio Bernasconi² 

[1] Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini, 5, Napoli NA, 80131, Naples, Italy;Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, University of Naples “Federico II”, Naples, Italy;

关键词: Case series;    Locoregional anesthesia;    Femoral nerve block;    Lateral femoral cutaneous nerve block;    Obturator nerve block;    Sciatic nerve block;   

DOI  :  10.1186/s13256-023-04017-6

 received in 2023-04-15, accepted in 2023-06-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe gold standard anesthesiologic procedure for urgent femur fracture surgery is Spinal Anesthesia. It is not always feasible because of patients' severe comorbidities and difficulties in optimizing drug therapy in the appropriate time frame such as discontinuation of anticoagulant drugs. The use of four peripheral nerve blocks (tetra-block) can be a winning weapon when all seems lost.Case presentationWe present, in this case series, three Caucasian adult femur fractures (an 83-year-old woman, a 73-year-old man, and a 68-year-old woman) with different and major comorbidities (cardiac or circulatory disorders on anticoagulants therapy that were not discontinued on time; breast cancer and others) underwent the same anesthesiologic approach in the urgent setting. Ultrasound peripheral nerve blocks, that is femoral, lateral femoral cutaneous, obturator, and sciatic with parasacral approach were successfully performed in all patients who underwent intramedullary nailing for intertrochanteric fracture. We evaluated the adequacy of the anesthesia plane, postoperative pain control with the VAS scale, and the incidence of postoperative side effects.ConclusionsFour peripheral nerve blocks (Tetra-block) can be alternative anesthesiologic management in urgent settings, in patients where drug therapy cannot be optimized, as in antiplatelet and anticoagulant therapy.

【 授权许可】

CC BY   
© The Author(s) 2023

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