Role of ultrasound guided epidural anesthesia for lower limb surgery in children with previously repaired meningomyelocele

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

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Successful use of ultrasound-guided peripheral nerve block for lower limb surgery in a patient with heart failure with reduced ejection fraction: a case report

Journal of International Medical Research ◽

10.1177/03000605211045230 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110452

Author(s):

Jaewoong Jung ◽

Misoon Lee ◽

Yang-Hoon Chung ◽

Sung-Hwan Cho

Keyword(s):

Heart Failure ◽

Sciatic Nerve ◽

Ejection Fraction ◽

Peripheral Nerve ◽

Lower Limb ◽

Peripheral Nerve Block ◽

Ultrasound Guided ◽

Reduced Ejection Fraction ◽

Lower Limb Surgery ◽

Fascia Iliaca Compartment Block

The number of patients with heart failure with reduced ejection fraction (HFrEF) is increasing. These patients have a reduced cardiorespiratory reserve. Therefore, preoperative evaluation is essential to determine the best type of anaesthesia to use in patients with HFrEF. A 70-year-old man with HFrEF was scheduled to undergo debridement of skin necrosis due to thrombotic occlusion of the right common iliac artery. He had undergone wound dressing changes under local anaesthesia every other day for several months, and treatment for heart failure was on-going. A sciatic nerve and fascia iliaca compartment block was performed under ultrasound guidance because of the patient’s cardiopulmonary function. After confirming adequate sensory blockage, surgery was performed without any haemodynamic instability or complications. Thereafter, debridement was performed twice more using the same block technique, and a skin autograft was also successfully performed. We successfully performed an ultrasound-guided sciatic nerve and fascia iliaca compartment block in a patient with HFrEF who was scheduled to undergo lower limb surgery. Peripheral nerve block is an alternative option for patients with HFrEF.

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118. Ultrasound-Guided Continuous Sciatic Nerve Block for Postoperative Pain Treatment After Lower Limb Surgery

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-00115550-200809001-00221 ◽

2008 ◽

Vol 33 (Suppl 1) ◽

pp. e115.2-e115

Author(s):

A. Martinez Navas ◽

R. Ortiz de la Tabla Gonzalez ◽

T. Vazquez Gutierrez ◽

P. Gomez Reja ◽

M. Reina Molina ◽

...

Keyword(s):

Postoperative Pain ◽

Sciatic Nerve ◽

Nerve Block ◽

Lower Limb ◽

Pain Treatment ◽

Sciatic Nerve Block ◽

Ultrasound Guided ◽

Lower Limb Surgery ◽

Postoperative Pain Treatment

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Clinical Effect of Combined Lumbar Epidural Anesthesia with Ropivacaine in Elderly Patients Undergoing Lower Limb Surgery

10.47939/mh.v2i1.38 ◽

2021 ◽

Keyword(s):

Elderly Patients ◽

Epidural Anesthesia ◽

Lower Limb ◽

Clinical Effect ◽

Lumbar Epidural Anesthesia ◽

Lower Limb Surgery

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Comparison of Ultrasound Guided Ankle Block versus Anatomical Landmark Guided Ankle Block in Minor Ankle and Foot Surgeries

10.53350/pjmhs2115113484 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3484-3487

Author(s):

Muhammad Nawaz Anjum ◽

Wajeeha Mufti ◽

Yasser Athar Shah ◽

Irfan Ali

Keyword(s):

Success Rate ◽

Regional Anesthesia ◽

Lower Limb ◽

Local Population ◽

Anatomical Landmark ◽

Anatomical Landmarks ◽

Block Group ◽

Ultrasound Guided ◽

Anatomic Landmark ◽

Lower Limb Surgery

Background: Regional anesthesia has increasingly expanded its role in perioperative care of patients undergoing foot and ankle surgery. The use of regional anesthesia has been widely implemented among anesthesiologists and pain providers. Multiple approaches for sephanous nerve blockade have been used including nerve stimulation, anatomical landmarks and ultrasound. It has been observed in previous studies that USG ankle block is more successful as compared to conventional anatomical landmark guided nerve block; so this study was planned to get precise and reliable results regarding both techniques in our local population. Objective: To compare the methods of surgical anesthesia of Ultrasound-guided ankle block versus conventional anatomic landmark-guided techniques in lower limb surgery under regional anesthesia. Materials and methods: This randomized control was carried out at Department of Anesthesia Mayo Hospital Lahore. After meeting the inclusion and exclusion criteria 50 patients (25 in each group ) were enrolled. Patients were randomly divided into two groups using lottery method. Group A patients underwent USG ankle block while group B patients underwent conventional anatomic landmark guided ankle block. Results: Mean age of patients was 46.96±11.578 years; 40(80%) patients were male and 10(20%) patients were females. Successful anesthesia was achieved in 42 (84%) patients; in which in USG block group the successful anesthesia was achieved in 22(88%) patients and in ALG block group successful anesthesia was achieved in 20(80%) patients (p value =0.702) Conclusion : Findings of this study conclude that both techniques have statistically insignificant difference in terms of success rate , however USG ankle block for surgical anesthesia showed higher success rate as compared to anatomic landmark guided technique in lower limb surgery under regional anesthesia. Keywords: Ultrasound-guided Ankle Block, Anatomic Landmark-guided Ankle Block, Lower limb surgery.

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