Introduction Discussion Conclusion References
Discussion
Introduction A scia'c nerve block at the level of popliteal fossa is one of the most useful and widely performed blocks in our prac'ce. Scia'c nerve block results in complete anaesthesia of the en're lower limb below the knee, with the excep'on of a strip of skin on the medial leg and foot, which is innervated by the saphenous nerve. Ultrasound guided scia'c nerve block at the popliteal fossa is performed with the lateral approach with pa'ent in the supine posi'on or with the lateral or posterior approach with pa'ent in the prone posi'on. Having an assistant to hold the leg, oxford posi'on, placing the leg on the chair are some of the posi'oning techniques that have been described in the literature so far to perform scia'c popliteal block in a supine pa'ent [1]. Although scanning the nerve in the popliteal fossa might be easier, posi'oning the pa'ent prone can be more cumbersome. However many 'mes, due to trauma or other considera'ons, it's not feasible to have the pa'ent lie prone. If the scia'c nerve block is performed with pa'ent in supine posi'on, sufficient space must be made to accommodate the transducer beneath the knee and thigh. This can be accomplished either by res'ng the foot on an elevated footrest or flexing the knee while an assistant stabilizes the foot and ankle on the bed. Different techniques have been described in the literature to posi'on the leg to perform popliteal block in a supine pa'ent like having an assistant to hold the leg, oxford posi'on, placing the leg on the chair etc. [2].
We would like to bring it to your aQen'on our prac'ce of using Carter Braine limb support for posi'oning the leg in a supine pa'ent. Whilst the pa'ent is supine, the leg to be operated upon is posi'oned on the Carter Braine support with 600 -‐ 900 flexion at hip and knee. This is to make sure that there is no undue stretch on the nerves, muscles or tendons and the pa'ent’s leg is comfortably posi'oned. This technique also allows room 0 for the probe to be 'lted caudally to bring the angle of incidence to 90 to the nerve. With this posi'oning technique, both in plane, in axis and in plane, out of axis block can be performed with ease. (See figures 1 & 2) The advantages of this posi'oning technique are that it is easy to use and easily accessible. Most importantly, there is no need for an extra person to hold the leg, thereby freeing up that person to inject the local anaesthe'c. We have been using this technique for the last few years with very good success and had been extremely popular amongst the anaesthe'c nurses
Figure: 1 Figure:2
Conclusion In conclusion, this posi'oning technique using Carter Braine arm support is convenient to the pa'ent, operator and his assistant, easy to use and aids in op'mizing ergonomics to improve the outcome [3].
References 1.Sinha A, Chan V W-‐Ultrasound imaging for popliteal scia'c nerve block. Reg Anesth Pain Med. 2004;29:130-‐134.MD, PhD, David M. Gaba, MD, Edward R. Mariano, MD 2.Pa'ent and Needle Posi'oning During Popliteal Nerve Block Birch, Mar'n D. FRCA; MaQhews, James L. FCAI; Galitzine, Svetlana V. FRCA 3.Preliminary Study of Ergonomic Behavior During Simulated Ultrasound-‐ Guided Regional Anesthesia Using a Head-‐Mounted DisplayAnkeet D. Udani, MD, T. Kyle Harrison, MD, Steven K. Howard, MD, T. Edward Kim,MD, John G. Brock-‐Utne
Introduction A scia'c nerve block at the level of popliteal fossa is one of the most useful and widely performed blocks in our prac'ce. Scia'c nerve block results in complete anaesthesia of the en're lower limb below the knee, with the excep'on of a strip of skin on the medial leg and foot, which is innervated by the saphenous nerve. Ultrasound guided scia'c nerve block at the popliteal fossa is performed with the lateral approach with pa'ent in the supine posi'on or with the lateral or posterior approach with pa'ent in the prone posi'on. Having an assistant to hold the leg, oxford posi'on, placing the leg on the chair are some of the posi'oning techniques that have been described in the literature so far to perform scia'c popliteal block in a supine pa'ent [1]. Although scanning the nerve in the popliteal fossa might be easier, posi'oning the pa'ent prone can be more cumbersome. However many 'mes, due to trauma or other considera'ons, it's not feasible to have the pa'ent lie prone. If the scia'c nerve block is performed with pa'ent in supine posi'on, sufficient space must be made to accommodate the transducer beneath the knee and thigh. This can be accomplished either by res'ng the foot on an elevated footrest or flexing the knee while an assistant stabilizes the foot and ankle on the bed. Different techniques have been described in the literature to posi'on the leg to perform popliteal block in a supine pa'ent like having an assistant to hold the leg, oxford posi'on, placing the leg on the chair etc. [2].
We would like to bring it to your aQen'on our prac'ce of using Carter Braine limb support for posi'oning the leg in a supine pa'ent. Whilst the pa'ent is supine, the leg to be operated upon is posi'oned on the Carter Braine support with 600 -‐ 900 flexion at hip and knee. This is to make sure that there is no undue stretch on the nerves, muscles or tendons and the pa'ent’s leg is comfortably posi'oned. This technique also allows room 0 for the probe to be 'lted caudally to bring the angle of incidence to 90 to the nerve. With this posi'oning technique, both in plane, in axis and in plane, out of axis block can be performed with ease. (See figures 1 & 2) The advantages of this posi'oning technique are that it is easy to use and easily accessible. Most importantly, there is no need for an extra person to hold the leg, thereby freeing up that person to inject the local anaesthe'c. We have been using this technique for the last few years with very good success and had been extremely popular amongst the anaesthe'c nurses
Figure: 1 Figure:2
Conclusion In conclusion, this posi'oning technique using Carter Braine arm support is convenient to the pa'ent, operator and his assistant, easy to use and aids in op'mizing ergonomics to improve the outcome [3].
References 1.Sinha A, Chan V W-‐Ultrasound imaging for popliteal scia'c nerve block. Reg Anesth Pain Med. 2004;29:130-‐134.MD, PhD, David M. Gaba, MD, Edward R. Mariano, MD 2.Pa'ent and Needle Posi'oning During Popliteal Nerve Block Birch, Mar'n D. FRCA; MaQhews, James L. FCAI; Galitzine, Svetlana V. FRCA 3.Preliminary Study of Ergonomic Behavior During Simulated Ultrasound-‐ Guided Regional Anesthesia Using a Head-‐Mounted DisplayAnkeet D. Udani, MD, T. Kyle Harrison, MD, Steven K. Howard, MD, T. Edward Kim,MD, John G. Brock-‐Utne
