Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series
Abstract Background The 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 antico...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
|
| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-04017-6 |
| _version_ | 1797789764400709632 |
|---|---|
| author | Antonio Coviello Carmine Iacovazzo Dario Cirillo Pasquale Diglio Alessio Bernasconi Andrea Cozzolino Antonio Izzo Annachiara Marra Giuseppe Servillo Maria Vargas |
| author_facet | Antonio Coviello Carmine Iacovazzo Dario Cirillo Pasquale Diglio Alessio Bernasconi Andrea Cozzolino Antonio Izzo Annachiara Marra Giuseppe Servillo Maria Vargas |
| author_sort | Antonio Coviello |
| collection | DOAJ |
| description | Abstract Background The 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 presentation We 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. Conclusions Four 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. |
| first_indexed | 2024-03-13T01:55:18Z |
| format | Article |
| id | doaj.art-415342b3af5b40a585074a53b9785f8c |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-13T01:55:18Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-415342b3af5b40a585074a53b9785f8c2023-07-02T11:16:52ZengBMCJournal of Medical Case Reports1752-19472023-07-0117111010.1186/s13256-023-04017-6Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case seriesAntonio Coviello0Carmine Iacovazzo1Dario Cirillo2Pasquale Diglio3Alessio Bernasconi4Andrea Cozzolino5Antonio Izzo6Annachiara Marra7Giuseppe Servillo8Maria Vargas9Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, University of Naples “Federico II”Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, University of Naples “Federico II”Unit of Orthopedics and Traumatology, Department of Public Health, School of Medicine, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”Abstract Background The 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 presentation We 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. Conclusions Four 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.https://doi.org/10.1186/s13256-023-04017-6Case seriesLocoregional anesthesiaFemoral nerve blockLateral femoral cutaneous nerve blockObturator nerve blockSciatic nerve block |
| spellingShingle | Antonio Coviello Carmine Iacovazzo Dario Cirillo Pasquale Diglio Alessio Bernasconi Andrea Cozzolino Antonio Izzo Annachiara Marra Giuseppe Servillo Maria Vargas 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 series Locoregional anesthesia Femoral nerve block Lateral femoral cutaneous nerve block Obturator nerve block Sciatic nerve block |
| title | Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series |
| title_full | Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series |
| title_fullStr | Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series |
| title_full_unstemmed | Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series |
| title_short | Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series |
| title_sort | tetra block ultrasound femoral lateral femoral cutaneous obturator and sciatic nerve blocks in lower limb anesthesia a case series |
| topic | Case series Locoregional anesthesia Femoral nerve block Lateral femoral cutaneous nerve block Obturator nerve block Sciatic nerve block |
| url | https://doi.org/10.1186/s13256-023-04017-6 |
| work_keys_str_mv | AT antoniocoviello tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT carmineiacovazzo tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT dariocirillo tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT pasqualediglio tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT alessiobernasconi tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT andreacozzolino tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT antonioizzo tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT annachiaramarra tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT giuseppeservillo tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries AT mariavargas tetrablockultrasoundfemorallateralfemoralcutaneousobturatorandsciaticnerveblocksinlowerlimbanesthesiaacaseseries |