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WHEN REGIONAL ANAESTHESIA SAVES THE DAY… AND THE PATIENT
Author(s): ,
Marques da Silva, R.
Affiliations:
Centro Hospitalar Vila Nova de Gaia Espinho, Anaesthesiology, Vila Nova de Gaia, Portugal
,
Alves, S.*
Affiliations:
Hospital de Braga, Anaesthesiology, Braga, Portugal
,
Vasconcelos Maria, L.
Affiliations:
Hospital de Braga, Anaesthesiology, Braga, Portugal
Fragoso, P.
Affiliations:
Hospital de Braga, Anaesthesiology, Braga, Portugal
ESRA Academy. Alves S. Sep 13, 2017; 190918; 326 Topic: Peripheral Nerve Blocks
Sara Alves
Sara Alves

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Abstract
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Background and Aims:

Trauma is an important public health problem. We present a case of a severe trauma patient who underwent several surgical procedures after a work accident.

Methods:

A 26 years old male, ASA II, was hospitalized due to severe trauma of both legs and lumbar spine. He underwent emergent surgery to correct an exposed fracture of the left leg under general anaesthesia. Following this procedure, spinal column was immobilized with a Jewett´s vest, and the right leg was immobilized pending for definitive treatment.

During hospital stay, the patient had an acute respiratory failure with alveolar bleeding. Aspiration pneumonia was suspected, as well as bacterial pneumonia and an autoimmune disease.

Surgery for correction of right tibia and fibula fractures was scheduled. For this procedure, neuraxial anaesthesia was unadvisable (spinal immobilization), and general anaesthesia could be dangerous (unclear respiratory pathology). It was decided that the best anesthetic option would be peripheral nerve blocks.Results:

We performed ultrasound-guided blocks of femoral, lateral femoral cutaneous and sciatic (subgluteal level) nerves with 175mg ropivacaine.

Optimal surgical conditions were achieved, with total sensitive block and partial motor block. The surgery took 3h30m, with mild pain complaints after 2h30m in the tourniquet area.Conclusions:

The main benefit of regional anesthetic techniques is the possibility of high-quality analgesia that is site-specific and devoid of systemic side effects. Ultrasound-guidance makes anaesthesia possible with smaller doses of local anesthetics.

In this case, peripheral nerve blocks were the most appropriate option, due to provision of adequate surgical conditions and patient safety.
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