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Technology and product review T ECHNOL OGY UPD A TE :


Sciatic nerve block: A useful procedure for diabetic foot surgery


Authors:


Florian Heid, Robert Kampka, Gunther Pestel, Tim Piepho


The range of comorbidities experienced by people who require lower-limb surgery to manage diabetic foot disease are many. These comorbidites make the undertaken of general anaesthesia both difficult and places them at high risk of complications during surgery or in the immediate postoperative period. In this article the authors present a description of a peripheral nerve block procedure as an alternative to general anaesthesia in patients undergoing lower-limb surgery. Two case reports are also presented.


anaesthesia.[1,2] P


eople with diabetic foot disease regularly have severe comorbidities resulting in a high-risk profile for General anaesthesia and


neuroaxial blockade (e.g. spinal anaesthesia) may impair hemodynamic stability. In people with diabetes who require podiatric surgery, peripheral nerve blocks targeting at the sciatic nerve may be a useful alternative to general anaesthesia.[3,4] The authors provide a detailed description of the sciatic nerve block technique, and two case reports.


Robert Kampka is Captain MD at the German Armed


Forces, Florian Heid, Gunther Pestel and Tim Piepho all are


Consultant Anaesthesiologists based at the Department of Anaesthesiology, Johannes


Gutenberg University Hospital, City of Mainz, Germany.


PRACTICAL PROCEDURE While in supine position, the sciatic nerve is identified by electric nerve stimulation through a lateral approach with an insulated needle being inserted at the middle of the patients’ thigh [FIGURE 1]. The correct position of the needle (we use NanoLine 22 g × 80 mm; Pajunk®, Germany) is confirmed by electric nerve stimulation. The electrical nerve stimulator (we use Stimuplex HNS 11®; Braun, Germany) produces an electrical current that depolarises the nerve membrane and causes contraction of the effector muscles of the relevant area. This confirms the proximity of the needle to the nerve. Foot flexion at 0.1 ms and 0.4 mA indicates adequate motor response and 40 mL of local anaesthetic (e.g. ropivacaine 0.5% or lidocaine 1.5%) are injected. If technical


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equipment and expertise are present, the sciatic nerve may also be localised by ultrasound. Some regions of the lower leg belong


to the saphenous nerve, which is the terminal branch of the femoral nerve. In order to achieve complete anaesthesia of the lower leg, this nerve has to be blocked by additional 10 mL of local anaesthetic (e.g. ropivacaine 0.5% or lidocaine 1.5%). Because the saphenous nerve only consists of sensory fibres, electric nerve stimulation may result in painful paraesthesia and is counterproductive. It is sufficient to inject into the subcutaneous wall reaching from the tuberositas tibiae to the medial caput of the gastrocnemius muscle [FIGURE 2]. However, the saphenous nerve can also be identified by ultrasound. Sufficient surgical anaesthesia is achieved 10–15 minutes after completion of injection. Characteristics of


Figure 1. Patient position and needle insertion for a sciatic nerve block.


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


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