3-in-1 lumbar plexus block for muscle biopsy in malignant hyperthermia patients. Amide local anaesthetics may be used safely

A 3-in-1 lumbar plexus block with the aid of a nerve stimulator was performed in 32 patients and a psoas compartment block was performed in five patients for muscle biopsy of the upper leg for diagnosis of malignant hyperthermia (MH) susceptibility. Twenty-two patients were found to be MH susceptible by the in vitro contracture test. Twenty patients received 40 ml prilocaine 1.5% with epinephrine 1:200,000 and two received 40 ml bupivacaine 0.5% with epinephrine 1:200,000 without any untoward reaction. The 3-in-1 block provides a high success rate and excellent analgesia for muscle biopsy of the upper leg. Amide local anaesthetics are safe in MH-susceptible patients.     

Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery

Background: The aim of this study was to compare the intra‐ and postoperative analgesia provided by the catheter‐technique psoas compartment block and the epidural block in hip‐fractured patients. We also compared hemodynamic stability, motor blockade, ease of performing the technique, and complications. Methods: Thirty patients who underwent partial hip replacement surgery were included in this prospective single‐blind study. Subjects were randomly assigned to Group E (n=15; general anesthesia plus epidural block with 15 ml of 0.5% bupivacaine) or Group P (n=15; general anesthesia plus psoas compartment block with 30 ml of 0.5% bupivacaine). Hemodynamic parameters were recorded at 10‐min intervals intraoperatively. Regional anesthesia procedure time, number of attempts at block, intraoperative blood loss, and need for supplemental fentanyl and/or ephedrine were noted. Postoperatively, a patient‐controlled analgesia device delivered an infusion and boluses of bupivacaine/fentanyl. Pain, motor blockade, ambulation time, patient satisfaction with analgesia, and complications were recorded postsurgery. Results: The epidural required significantly more attempts than the psoas block, thus procedure time was longer in this group. Group E also showed significantly greater drops in mean arterial blood pressure from baseline at 30, 40 and 50 min after the start of general anesthesia. Significantly more Group E patients required epinephrine supplementation. The groups were similar regarding pain scores (at rest and on movement) and patient satisfaction, but Group E had higher motor blockade scores, longer ambulation time, and significantly more complications. Conclusion: The continuous psoas compartment block provides excellent intraoperative and postoperative analgesia with a low incidence of complications for partial hip replacement surgery     

Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures

BACKGROUND AND OBJECTIVES: The perioperative use of continuous psoas compartment block (CPCB) was compared with traditional pain management for patients with fracture of the femur. The anatomy of CPCB was also tested in cadavers. METHODS: Forty consecutive patients (range, 67-96 years old) were prospectively randomized either to group A (given local anesthetics using a CPCB) or group B (given perioperative analgesia with meperidine). In another part of the study, CPCB was performed in 15 fresh cadavers, and dissection of the lumbar region was performed after dye injection. RESULTS: Continuous psoas compartment block was performed successfully in all patients in group A and was used in the pre- (16-48 hours) and postoperative (72 hours) periods. Visual analog scale score in group A was lower than in group B in 5/7 preoperative and 9/9 postoperative 8 hourly assessments. Differences reached statistical significance (P < .05) in 3 and 5 of the assessments, respectively. Patient satisfaction was higher in group A in the pre- (P < .05) and postoperative periods (P<.03). The block failed to achieve surgical anesthesia in 85% (17/20) of the patients, and additional anesthesia was needed. The anatomic study failed to support the existence of a defined "psoas compartment" previously described, and supported the clinical findings. Injected dye was found in the region of the origin of the sciatic nerve (essential for the production of anesthesia for hip surgery) in only 26% (4/15) of cadavers. CONCLUSIONS: The CPCB seems to be an appropriate technique for efficient and safe perioperative pain control. However, in our dissections, the psoas compartment was not well defined in all patients, thus, using this route for anesthesia may result in only partial success.     

Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks

Background and Objectives. Recently it has been demonstrated that the use of ultrasound (US) improves the onset time and the quality of sensory block for 3-in-1 blocks compared with conventional nerve stimulator (NS) techniques. The present study was designed to evaluate if US guidance for 3-in-1 blocks reduces the amount of local anesthetic compared to NS guidance. Methods. After institutional approval and informed consent, 60 patients undergoing hip surgery following trauma were randomly assigned to three groups of 20 patients each. In group A, the 3-in-1 block was performed using US guidance with 20 mL 0.5% bupivacaine. Group B received 20 mL 0.5% bupivacaine, and group C received 30 mL 0.5% bupivacaine during NS guidance. The quality and the onset time was assessed by pinprick test in the central sensory region of each of the three targeted nerves and compared with the contralateral leg every 10 minutes for 1 hour by a blinded observer. The rating was undertaken using a scale from 100% (uncompromised sensibility) to 0% (no sensation). Results. Overall success for the 3-in-1 block in group A was 95% and in groups B and C 80%. Onset time was significantly shorter in the US-guided group compared with both NS-guided groups (group A 13 ± 6 minutes; group B 27 ± 12 minutes; and group C 26 ± 13 minutes; P < .01 to groups B and C). Quality of sensory block was significantly better in group A (4% ± 5% of initial value) compared with groups B and C (group B 21% ± 11% of initial value, P < .01 to group A; group C 22% ± 19%, P < .01 to group A). Conclusion. The amount of local anesthetic for 3-in-1 blocks can be reduced by using US guidance compared with the conventional NS-guided technique.     

改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的应用

目的观察改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果。方法选择择期行单侧大隐静脉高位结扎加抽剥术患者60例,男32例,女28例,年龄42~76岁,ASAⅠ或Ⅱ级,采用随机数字表法将其分为改良髂筋膜间隙联合腘窝坐骨神经阻滞组(N组)和硬膜外阻滞组(E组),每组30例。N组先行腘窝坐骨神经阻滞,再在超声图像上确认髂筋膜和股神经位置,先行股神经阻滞,再在同一穿刺点从缝匠肌内侧缘开始,由外向内沿髂筋膜下给1%利多卡因10ml和0.5%罗哌卡因10ml,同时超声探头在腹股沟韧带水平向内移动,内侧达股动脉上方;E组采用L2~3间隙行硬膜外阻滞。记录两组阻滞前(T0)、阻滞后10min(T1)、30min(T2)、60min(T3)的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术中麻黄碱使用情况、麻醉效果及术后48h恶心呕吐、头痛及尿潴留发生情况。结果与T0时比较,T2时E组的SBP和DBP明显降低(P0.05),T2时N组SBP和DBP明显高于E组(P0.05);N组感觉阻滞起效时间明显短于E组、术中麻黄碱使用率明显低于E组(P0.05);E组整体麻醉效果优于N组(P0.05),但两组麻醉效果优良率差异无统计学意义;术后48hN组尿潴留发生率明显低于E组(P0.05)。结论改良髂筋膜间隙联合腘窝坐骨神经阻滞用于单侧大隐静脉高位结扎加抽剥术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小、术后并发症少及适应证更广等优点。     

Psoas compartment block in children: Part I--description of the technique

BACKGROUND: Until recently only small series of psoas compartment blocks (PCB) in children have been reported. A high incidence of epidural spread as an important side effect was noted. A series of 100 consecutive blocks using new standardized landmarks is reported. METHODS: In 100 consecutive children (5.9-106 kg) PCB was performed using a nerve stimulator. In the lateral position, the needle was inserted between the medial 2/3 and the lateral 1/3 on a line from the spinous process of L4 to the posterior superior iliac spine. The blocks were performed by residents in training under supervision of one specific designated pediatric anesthetist. RESULTS: All blocks were clinically successful. In 64% only one attempt was necessary, in 26 patients two attempts were necessary and in 10 patients more than two attempts were necessary. In 16% a vascular puncture occurred. In one patient with a dense unilateral block a partial epidural spread occurred. No serious complications were observed during the perioperative period. CONCLUSIONS: The described new technique has a very high success rate with no relevant side effects. Although only one case of epidural spread occurred, PCB remains an invasive technique with the potential for serious complications.     

不同浓度罗比卡因腰丛联合坐骨神经阻滞用于膝关节镜手术的比较

目的观察一定剂量的罗比卡因配成不同浓度溶液用于腰丛联合坐骨神经阻滞在膝关节镜手术的麻醉效果比较.方法40例拟行单侧膝关节镜手术患者随机分为A、B两组,每组20例,均在神经刺激仪定位下行腰丛联合坐骨神经阻滞,在腰丛神经和坐骨神经处均分别注入罗比卡因150 mg.A组将150 mg罗比卡因稀释到20 ml使用,即浓度为0.75%;B组稀释到30 ml,即浓度为0.5%.观察患者感觉和运动阻滞起效时间及维持时间,以及麻醉满意程度.结果两组患者感觉阻滞维持时间差异无显著性（P＞0.05）,感觉及运动阻滞起效时间A组比B组明显缩短（P＜0.05）,而运动阻滞维持时间A组明显延长（P＜0.05）,麻醉满意度B组明显优于A组（P＜0.05）.结论A组麻醉比B组起效快,但只运动阻滞时间明显延长,且麻醉满意度较差.所以在相同剂量的情况下,用0.5%的罗比卡因比用0.75%的罗比卡因行腰丛联合坐骨神经阻滞更适合于膝关节镜手术.     

关节镜辅助单髁置换术治疗膝内侧间室骨性关节炎的临床疗效观察

目的总结关节镜辅助单髁置换术治疗膝内侧间室骨性关节炎的临床疗效。方法选择自2008-03—2011-01行手术治疗的18例单侧膝关节骨性关节炎。均以膝关节内侧间室病损为主。术前进行MR及X线片评估;术中采用关节镜进行检查和清理。并行膝关节内侧间室单髁置换术：术后进行膝关节功能及影像学评估。结果所有患者均获平均21（18～36）个月随访,影像学检查显示假体位置良好,无松动与假体周围骨溶解的迹象。末次随访时膝关节功能HSS评分由术前71．3分提高至87．2分,优15膝,良3膝;平均关节活动范围（ROM）127°（112～141°）。结论关节镜下准确评估、清理关节病损为人工膝关节单髁置换术提供临床依据,提高了疗效,是治疗膝关节单间室骨性关节炎的有效方法。     

Effects of using the posterior or anterior approaches to the lumbar plexus on the minimum effective anesthetic concentration (MEAC) of mepivacaine required to block the femoral nerve: a prospective, randomized, up-and-down study

BACKGROUND AND OBJECTIVES: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. METHODS: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). RESULTS: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED(50)) was 1.06% +/- 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% +/- 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). CONCLUSIONS: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.     

A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy

The optimal anesthetic technique for outpatient knee arthroscopy remains controversial. In this study, we evaluated surgical operating conditions, patient satisfaction, recovery times, and postoperative analgesic requirements associated with psoas compartment block, general anesthetic, or spinal anesthetic techniques. Sixty patients were randomized to receive a propofol/nitrous oxide/fentanyl general anesthetic, spinal anesthesia with 6 mg of bupivacaine and 15 micro g of fentanyl, or psoas compartment block with 40 mL of 1.5% mepivacaine. All patients received IV ketorolac and intraarticular bupivacaine. The frequency of postanesthesia recovery room admission was 13 (65%) of 20 for patients receiving general anesthesia, compared with 0 of 21 for patients receiving spinal anesthesia and 1 (5%) of 19 for patients receiving psoas block (P < 0.001). The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups (131, 129, and 110 min for general, spinal, and psoas groups, respectively). In the hospital, 45% of general anesthesia patients received opioid analgesics, compared with 14% of spinal anesthesia and 21% of psoas block patients (P = 0.087). There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia. Pain scores were highest in patients receiving general anesthesia at 30 min (P = 0.032) and at 60, 90, and 120 min (P < 0.001). Patient satisfaction with anesthetic technique (P = 0.025) and pain management (P = 0.009) differed significantly across groups; patients receiving general anesthesia reported lower satisfaction ratings. We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering resource utilization, patient satisfaction, and postoperative analgesic management. IMPLICATIONS: Outpatient knee arthroscopy may be performed using a variety of anesthetic techniques. We report that spinal anesthesia and psoas compartment block are superior to general anesthesia when considering resource utilization, patient satisfaction, and postoperative analgesic management.     

Ultrasound guided two-in-one technique for sciatic and femoral nerve block in below knee surgery: Comparison between two entry points

BackgroundAnesthesia for lower limb surgery requires the combination of femoral and sciatic nerve blocks. Although the anterior approach to the sciatic nerve block has rarely been performed, ultrasound guidance may make performance of this approach easier. This prospective, randomized, double blind study was designed to evaluate the success rate, the clinical use and complications of performing ultrasound-guided combined sciatic and femoral nerve block with one needle entry technique in adult patients scheduled for below knee surgery using two different anterior approaches.Patients and methodsFifty-one patients ASA1 and 11 (25–49 years) were randomly divided into two groups according to the method used for identification of the puncture point: (Para n = 26) using the parafemoral approach, (Aysun n = 25) using Aysun et al. approach for anterior sciatic nerve block using 0.5% bupivacaine 20 ml for each block. Measurements included block execution time, needle and nerve depth, onset time of sensory and motor block, duration of the block, the degree and the quality of block.ResultsThe sciatic nerve was located significantly deeper and the needle depth was significantly greater in Para group compared with Aysun group. The execution time of the sciatic nerve block and for the combined sciatic and femoral nerve block were statistically significant longer in Para group than Aysun group. There were no statistically significant differences in success rate, onset time or duration of blockade between the two groups. In 24 cases of each group, complete sensory and motor block (successful block) were obtained. No patient in both groups had a failed block. For patients with complete block, there was no statistical difference regarding the quality of block in both groups, No side effects or complication were recorded in both groups.ConclusionCombined sciatic and femoral block guided with US could be performed easily, successfully and safely in adult patients using single needle/one puncture point technique through two different anterior approaches.     

The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta‐analysis

The aim of this meta‐analysis was to assess the postoperative analgesic efficacy of sciatic nerve block when combined with femoral nerve block after total knee arthroplasty. Outcomes included resting pain scores (analogue scale, 0–100), intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively, and functional outcomes comprising knee flexion, distance walked, and length of stay. Twelve randomised controlled trials were included, with a total of 600 patients. When combined with femoral nerve block, sciatic nerve block significantly reduced resting pain scores at 12 h postoperatively with a mean difference of 10 (95% CI: ?15 to ?5; p < 0.00001). Resting pain scores at 24 h, and intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively were also significantly reduced, but without clinical significance beyond 12 h and without affecting functional outcomes. In conclusion, sciatic nerve block confers additional postoperative analgesia within the first 12 postoperative hours compared with femoral nerve block alone for patients undergoing total knee arthroplasty.     

股神经阻滞联合无止血带技术在全膝关节置换术中的应用及效果

目的探讨股神经阻滞联合无止血带技术在全膝关节置换术(TKA)中的应用,并分析其在减轻术后疼痛中的作用及对术后认知功能的影响。方法本院2016年1月至2018年1月行TKA患者251例,男117例,女134例,年龄18～80岁,BMI 16.9～31.7 kg/m~2,ASAⅠ—Ⅲ级,随机分为四组:止血带下膝关节置换+静脉镇痛组(PT1组,n=56);止血带下膝关节置换+股神经阻滞镇痛组(PT2组,n=63);无止血带下膝关节置换+静脉镇痛组(P1组,n=56);无止血带下膝关节置换+股神经阻滞镇痛组(P2组,n=76)。分别于术前1 d、术后1、2、3 d测量术侧大腿中上1/3处周长,并于同时点采集外周静脉血测定白细胞计数(WBC)、中性粒细胞百分比(NEUT%)、C-反应蛋白(CRP)浓度。分别于术前1 d、术后1、2、3、7 d和3个月评测患侧膝关节活动度(AROM),采用视觉模拟疼痛评分法(VAS)评估静息和活动时的疼痛VAS评分。分别于术前1 d、术后1、2、3 d采用蒙特利尔认知评估量表(MoCA)评估患者认知功能,记录术后3 d内认知功能损害发生情况和恶心呕吐(PONV)发生情况。结果术后1、2、3 d PT1组和PT2组大腿周长增加值明显大于P1组和P2组(P0.05)、CRP浓度明显低于P1组和P2组(P0.05)。术后1、2 d PT1和P1组AROM明显小于PT2组和P2组(P0.05),PT1组静息和活动时VAS评分明显高于PT2组、P1组和P2组(P0.05),且P1组活动时VAS评分明显高于PT2组和P2组(P0.05)。术后1 d PT1组和PT2组MoCA评分明显高于P1组和P2组(P0.05)。术后3 d内PT1组和PT2组认知功能损害总发生率明显低于P1组和P2组(P0.05),PT1组和P1组PONV的总发生率明显高于PT2组和P2组(P0.05)。结论持续股神经阻滞联合无止血带技术用于全膝关节置换术,患者术后大腿肿胀及疼痛程度较轻,利于膝关节功能锻炼,关节活动度恢复快,但术后全身炎症反应较重且术后早期认知功能损害发生率增加。     

超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋关节术后镇痛的比较

目的比较腰方肌阻滞(quadratus lumborum block,QLB)和髂筋膜间隙阻滞(fasciailiaca compartment block,FICB)在老年髋关节置换术的镇痛效果。方法选择择期拟行腰麻下全髋关节置换术的老年患者55例,男22例,女33例,年龄65～85岁,ASAⅠ或Ⅱ级,随机分为QLB组(n=28)和FICB组(n=27)。术后分别于超声引导下行QLB和FICB,予0.375%罗哌卡因30ml。所有患者术后行舒芬太尼静脉自控镇痛。记录术后6、12、24、48h镇痛泵按压次数及舒芬太尼用量;记录静息及运动时VAS疼痛评分;记录术后恶心呕吐、眩晕等不良反应情况。结果术后12、24、48h QLB组镇痛泵按压次数及舒芬太尼用量明显少于FICB组(P0.05);术后12、24、48hQLB组运动时VAS评分明显低于FICB组(P0.05),两组不同时点静息时VAS评分差异无统计学意义;QLB组恶心呕吐发生率明显低于FICB组[2(7.1%)vs 9(33.3%),P0.05]。结论腰方肌阻滞较髂筋膜间隙阻滞更能明显减轻髋关节置换术后活动痛,减少阿片类药物的使用及不良反应发生率。     

超声引导前路坐骨神经阻滞多点与单点注射的比较

目的比较超声引导前路坐骨神经阻滞多点注射与单点注射技术的差异。方法选择行足踝部手术患者90例,男47例,女43例,年龄18~68岁,ASAⅠ~Ⅲ级,随机分为多点注射组(M组)和单点注射组(S组),每组45例。超声引导行前路坐骨神经阻滞,分别给予0.5%盐酸罗哌卡因20ml。记录两组坐骨神经宽度、厚度、深度及阻滞操作时间;注射局麻药后10、20和30min时运动阻滞及腓浅神经、腓肠神经、腓深神经、胫神经感觉阻滞情况;麻醉相关并发症的发生情况。结果超声图像上两组坐骨神经宽度、厚度、深度差异无统计意义。M组阻滞操作时间明显长于S组(P0.05),腓浅神经在注药后10、20和30 min、腓肠神经在注药后20和30 min、胫神经在注药后30min的感觉阻滞完善率M组明显高于S组(P0.05),注药后30 min时M组足跖屈、背伸运动阻滞完善率明显高于S组(P0.05),两组术后恶心呕吐、耳鸣等不良反应差异无统计学意义。结论超声引导经前路坐骨神经阻滞多点注射局麻药较单点注射需要更多操作时间,但感觉、运动阻滞起效快,两组术后恶心呕吐、耳鸣等不良反应差异无统计学意义。     

A description of the spread of injectate after psoas compartment block using magnetic resonance imaging

BACKGROUND AND OBJECTIVES: Magnetic resonance imaging (MRI) provides for excellent visualization of spread of solution after peripheral nerve block. The aim of this observational study was to utilize MRI to describe the distribution of injectate (gadopentetate dimeglumine) administered for continuous psoas compartment block (PCB) performed by use of two approaches (Capdevila and modified Winnie) and to describe the spread of injectate to the lumbar plexus. METHODS: Four volunteers were enrolled in a prospective crossover study. Each volunteer underwent PCB with catheter placement performed by use of Capdevila's approach followed 1 week later by PCB, with catheter placement performed by use of a modified Winnie approach. MRI of injectate distribution was performed after each PCB. RESULTS: The catheter was unable to be inserted in 1 volunteer undergoing Winnie's approach; therefore, 7 sets of MR images were analyzed. In 6 of 7 cases (4 Capdevila and 2 Winnie) spread was primarily within the psoas muscle. Contrast surrounded the L2-3 lumbar branch of the femoral nerve at L4 and cleaved the fascial plane within the psoas muscle and spread cephalad to reach the lumbar nerve roots. In 1 case (Winnie approach) contrast spread between the psoas and quadratus lumborum muscles. Contrast surrounded the femoral and obturator nerves where they lie outside the psoas muscle at L5. CONCLUSION: The most common pattern of injectate spread seen on MRI with both approaches to PCB was spread within the body of the psoas muscle around the lumbar branches (L2-4), with cephalad spread to the lumbar nerve roots. One catheter resulted in injectate between the psoas and quadratus lumborum muscles.     

Comparison of the fascia iliaca compartment block with the 3-in-1 block in children

A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.     

Combined sciatic and femoral nerve block for knee arthroscopy: 4 years’ experience

Selective block of the femoral and sciatic nerves was performed on 601 patients undergoing knee arthroscopy. The results were good in 87%, adequate in 12%, and poor in 1%. The whole knee surface was covered by the nerve blockade. The duration of anesthesia was 152 ± 21 min and that of analgesia, was 336 ± 18 min. No correlation was observed between the effectiveness of the anesthesia and type of surgery performed. The technique described thus proved adequate for knee arthroscopic surgery, reproducibility was excellent, costs and hospital stays were reduced with respect to general anesthesia, and surgeon and patient satisfaction was high. Received: 25 May 1998