Sciatic + Femoral Nerve Blocks for AKA Amputation
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- Опубліковано 24 кві 2024
- This video demonstrates the combined femoral and sciatic nerve blocks in patients undergoing major lower extremity amputations (MLEA), such as above-knee (AKA) or below-knee (BKA) amputations. These patients often have multiple comorbidities, including diabetes, cardiovascular, and renal disorders, making them poor candidates for general, and sometimes even spinal anesthesia due to heightened risks of postoperative complications, and/or risk of spinal hematoma. In the video, we combined these blocks with liposomal bupivacaine (Exparel®) to extend the analgesic benefits even much longer into the postoperative period, as documented in a study by Schwartz and colleagues.
Here are the Key Insights from the Video:
1. High Mortality Rates Post-MLEA: Research shows a 20% mortality rate within 30 days and nearly 50% within a year following MLEA. Our techniques aim to mitigate these risks.
2. Objective of Anesthetic Management: We focus on minimizing anesthetic risks while providing effective postoperative analgesia. This approach not only alleviates patient suffering but also promotes early mobilization.
3. Benefits of Combined Nerve Blocks: The use of subgluteal sciatic and femoral nerve blocks during surgeries for lower extremity amputation maintains stable hemodynamics and reduces the risk of intraoperative and postoperative morbidity.
4. Enhancement with Exparel: We incorporate Exparel in approved indications for sciatic and femoral blocks, optimizing anesthesia and improving outcomes for our most vulnerable patients.
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's UA-cam channel is accurate.
Hello! Is IT enough? What about obturator nerv and lateral cutaneus nerv??
I was thinking just about that! The lateral and medial sensory territory aspect of the tight
Without these two nerve block, cannot do AK amputation. Lumbar plexus block would be better.
Very nice. I prefer an anterior approach to both sciatic and femoral nerve blocks. The patient doesn't have to be turned, and you can use only one needle in some smaller patients.
It would be easier in a patient of this body frame.
Thank you for your videos, big fan of your work!
How long can the analgesia last with this combination?
I thought you also need to block the obturator and the latera cutaneous nerve of the thigh
Can you give us some info about the percentage of the solution and the approximate quantity, please?
How about the tolerance of tourniquet pain during surgery??
Thank you! Very well!
Glad it was helpful!
What about a one sided spinal? Do you think it's underutilized?
Nice video, really appreciate this.
Any need to block posterior cutaneous nerve of thigh, subgluteal approach cannot reliably cover it. What about obturator is it needed?
Yes, ideally. Sometimes it is blocked with proximal sciatic. But a couple of cc of local will do, when a problem. Greetings and thanks for watching!
Wonderfull, but one doubt, with that technique there is no need to block crural nerve????
If you block everything - it becomes complicated and difficult to reproduce. 1-2 ml of local bu the srugeon if the crucal nerve is an issue is no brainer! Greetings and thanks for watching!
@@nysoravideo thanks you for your answer 👍🏼👍🏼👍🏼👍🏼
Is there any necessary for obturator block
Too complicated. 3 nerves blocks = more time, more discomfort. A few ml of local will do, when necessary. Greetings and thanks for watching!
Thanks
What about Lat femoral cut and obturator nerves block for such operation
Larger volume for femoral covers LFCN. Obturator is important only for higher AKA. Import - do not complicate, you can always use a few ml of local for what is not blocked - safe than trying to block everything and wasting time and increasing the risk of LAST. KSS pricniple.
What is KSS principle by the way?
@@nysoravideo Not sure I'd agree with that logic. You're presenting an AKA under peripheral blocks, avoiding spinal and GA. Advocating extra volume for LFCN when you can target it easily, and it will absolutely be in the surgical area. Obturator may, or may not be involved, with significant variability. Why not save the volume (and thus dose of LA and risk of LA toxicity), and target the LFCN as well as the obturator. In these patients, i'd rather specific, targeted, low volume blocks, rather than leaving things to chance (spread via volume, or risking lack of obturator involvement).
KSS: stands for "Keep it Simple Stupid". It is not meant to be offensive, just to remind people that the more complicated you make something, the higher the risk of a failure occuring
@@kamakshiguna298
Why not wait few days and do spinal? With surgeon infiltrating sciatic nerve with bupi intraoperative. You would have extra days to better prepare your patiente.
This approach for scatic n block I think not enough it bypass posterior cutaneous n of the thigh you need to go more higher gluteal approach plus u need to block also lateral cutaneous n of the thigh and obturator