Poster on USG guided popliteal sciatic nerve block in tibial osteochondroma surgery of anterior leg

1. ULTRASOUND GUIDED POPLITEAL SCIATIC NERVE BLOCK FOR OSTEO-CHONDROMA OF TIBIA IN A SYMPTOMATIC RHEUMATIC HEART DISEASE ADOLESCENTS MALE
PATIENT WITH HEART FAILURE & REDUCED EJECTION FRACTION.
AUTHOR: DR. SANTOSH KUMAR JR(ACAD) (ISA NO: S8006/A)
DR. (PROF) BIJOY KUMAR PROFFESSOR & HOD DEPT OF ANESTHESIOLOGY NMCH PATNA
INTRODUCTION:- Rheumatic heart disease is common in child and adolescent population of India. Patients with RHD with HF and reduced ejection
fraction have poor outcomes and high mortality owing to a reduced cardiorespiratory reserve. The type of anesthesia is chosen on the basis of these results,
the patient’s condition, and the surgical site. General anesthesia and central neuraxial blockade can cause hemodynamic instability and other complications.
We successfully performed USG-guided popliteal sciatic nerve block(PNB), while maintaining hemodynamic stability and preventing other complications in a
patient who was scheduled to undergo tibial osteochondroma excision.
CASE REPORT:-A 14 year old adolescents male had rheumatic
heart disease since 5year of age. Patient was scheduled for
excision of tibial osteochondroma in Nalanda Medical College &
Hospital Patna. The informed consent form was signed. On
physical examination, weight 30 kg, blood pressure 100/50 mmHg,
heart rate 100 bpm, respiratory auscultation revealed breath
sounds with bilateral basal crepts, ; cardiac auscultation shows
low pitch murmur in the apex region, mallampati 2,.Pre-op ECG
shows bifid p wave in v1 and slight RAD , Echo- severe MS with
mod MR , mod PAH, No clots, RV dysfunction also present, EF
30% LA dilated. In the operating room patient was positioned in
supine position. ECG, SpO2,NIBP was attached. ultrasound
guided popliteal-sciatic nerve block was performed using 10 ml of
0.5% bupivacaine and 10 ml of 2% lox with adrenaline.
REFERENCES:
1. Smit-Fun V, Buhre WF.The
patient with chronic heart failure
undergoing surgery
2. Ituk US, Habib AS, Polin CM, et
al.
3. Karm MH, Lee S, Yoon SH, et
al.]
DISCUSSION : Our patient had severely compromised
cardiovascular function. Several studies have shown that PNB has
many advantages compared with general anesthesia, such as
superior postoperative analgesia, improved postoperative
mortality, intraoperative hemodynamic stability, and a reduced
incidence of pulmonary complications. The advantages of a USG
nerve block over landmark or nerve stimulator are well known.
Ultrasound guidance enables direct visualization of anatomical
structures, the needle pathway, and the distribution of local
anesthetics, and this visualisation accelerates the onset of
blockade, increases accuracy, and reduces the dose of the local
anesthetic.
CONCLUSION : Nerve block can
be considered as one of the best
alternatives in patients with high
risks in whom GA or neuroaxial
blockade can cause further
deterioration in pre-existing
condition. Perioperative
management in a case of
symptomatic rheumatic disease
with heart failure & reduced
ejection fraction may be
challenging due to various cardiac
manifestations. Peripheral nerve
block as mode of anesthesia are
beneficial to minimize any cardiac
or respiratory complications in
these patients