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FEMORAL NERVE BLOCK AS AN ANALGESIC STRATEGY FOR AMBULATORY VARICOSE VEINS SURGERY – HOW TO OVERCOME UNDESIRABLE EFFECTS?A CASE REPORT
ESRA Academy. Silva E. Sep 8, 2016; 138585
Topic: SAFETY AND COMPLICATIONS OF REGIONAL ANAESTHESIA (RA)
Eva Silva
Eva Silva

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Abstract
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Background and Aims:

A main concern with a femoral nerve block is the risk of falling by quadriceps motor block. Other complications include nerve injury, infection, bleeding and system toxicity, which are rare but can be devastating. We applied a femoral blockade to a patient undergoing unilateral long saphenous vein stripping surgery in our ambulatory unit. 

Methods:

Under written patient consent, an ultrasound-guided right femoral block was performed in a 63 year-old ASA I woman, previously operated to an inguinal hernia. A single-shot 15mL of ropivacaine 0,25% was injected prior to anaesthetic induction, with no adverse events. The intervention took ninety minutes under balanced general anaesthesia. Intra-operative analgesia consisted of intravenous paracetamol 1g and parecoxib 40mg.

Results:

After the surgery, the patient was taken to post-anaesthesia care unit, where she mentioned pain and the need for additional analgesia (intravenous tramadol 50mg) thirty minutes after admission. The patient maintained important unilateral sensitive blockade eleven hours following the regional technique. This event motivated the delay of the patient´s discharge to the next day, where no side effects were recorded.

Conclusions:

The presence of a sustained blockade provides an additional concern on the possible causes underlying that condition. As an analgesic strategy, it is important to consider a reduction on the concentration of the local anaesthetic or even a different one, in order to minimize the possibility of a longstanding block in an ambulatory regime. Despite the advantages of an analgesic peripheral blockade, we should always take into consideration the possible adverse effects and know how to manage them.

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