Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44) Gi-Soo Lee, Chan Kang*, You Gun Won, Byung-Hak Oh, June-Bum Jun Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea *Department of Orthopedic Surgery, University of Medicine, Chung-Nam, Daejeon, Korea
Disclosure No Conflict to Disclore Gi-Soo Lee Chan Kang* You Gun Won Byung-Hak Oh June-Bum Jun Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea *Department of Orthopedic Surgery, University of Medicine, Chung-Nam, Daejeon, Korea
Introduction External fixation requires a long preoperative time owing to NPO requirement, evaluation of underlying diseases and cooperation with an anesthetist. In an effort to compare the time to surgery, outcomes following surgery, we undertook a RCT of patients undergoing external fixation to evaluate the usefulness of ultrasound(us)-guided nerve block(nb) and general anesthesia(ga)
Material and Method Patients who undergo emergency external fixation surgery between June 2014 and April 2016 and were classified as AO types 42, 43, and 44 were included (Table 1)
Material and Method To evaluate the patients satisfaction with anesthesia, patients were asked to complete a questionnaire.
Results The lead time before the start of the operation in GA group was longer than that in the US-guided NB group. All patients in the US guided NB group chose US-guided NB over GA as their preferred anesthetic method for any possible future operation. (Table 3)
Conclusion US-guided NB is considered an effective anesthesia method in emergency external fixation in patients with lower-extremity trauma. It is a fast and safe method without restriction of NPO time and reduce the frequency of complications and facilitating recovery. This method is expected to be used in the future for various diseases without restrictions in time, space, and patient conditions
References 1. Casati, A, Borghi, B, Fanelli, G, et al. A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesthesia & Analgesia. 2002;94(4):987-990. 2. Casati, A, Chelly, JE, Cerchierini, E, et al. Clinical properties of levobupivacaine or racemic bupivacaine for sciatic nerve block. Journal of clinical anesthesia. 2002;14(2):111-114. 3. Domingo-Triadó, V, Selfa, S, Martínez, F, et al. Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective, comparative, randomized study. Anesthesia & Analgesia. 2007;104(5):1270-1274. 4. Egol, KA, Tejwani, NC, Capla, EL, Wolinsky, PL, Koval, KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. Journal of orthopaedic trauma. 2005;19(7):448-455. 5. Fernández Guisasola, J, Andueza, A, Burgos, E, et al. A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa. Acta anaesthesiologica scandinavica. 2001;45(8):967-970. 6. Fredrickson, MJ, Kilfoyle, DH. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia. 2009;64(8):836-844. doi:10.1111/j.1365-2044.2009.05938.x. 7. Helayel, PE, da Conceicao, DB, Pavei, P, Knaesel, JA, de Oliveira Filho, GR. Ultrasound-guided obturator nerve block: a preliminary report of a case series. Reg Anesth Pain Med. 2007;32(3):221-226. doi:10.1016/j.rapm.2007.01.006. 8. Jacobson, E, Forssblad, M, Rosenberg, J, Westman, L, Weidenhielm, L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy. 2000;16(2):183-190. 9. Jung, G-H. Management of Open Fracture. Journal of the Korean Fracture Society. 2010;23(2):236-250. 10. Kim, J-W, Oh, C-W, Oh, J-K, et al. Staged minimally invasive plate osteosynthesis of proximal tibial fracture. Journal of the Korean Fracture Society. 2009;22(1):6-12. 11. Kim, YM, Joo, YB, Kang, C, Song, JH. Can ultrasound-guided nerve block be a useful method of anesthesia for arthroscopic knee surgery? Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2090-2096. doi:10.1007/s00167-014-3281-1. 12. Kim, YM, Kang, C, Joo, YB, et al. Usefulness of Ultrasound-Guided Lower Extremity Nerve Blockade in Surgery for Patellar Fracture. Knee Surg Relat Res. 2015;27(2):108-116. doi:10.5792/ksrr.2015.27.2.108. 13. Marhofer, P, Greher, M, Kapral, S. Ultrasound guidance in regional anaesthesia. British Journal of Anaesthesia. 2005;94(1):7-17. 14. Markham, A, Faulds, D. Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs. 1996;52(3):429-449. 15. Myerson, MS, Ruland, CM, Allon, SM. Regional anesthesia for foot and ankle surgery. Foot & Ankle International. 1992;13(5):282-288. 16. Parrett, BM, Matros, E, Pribaz, JJ, Orgill, DP. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plastic and reconstructive surgery. 2006;117(4):1315-1322. 17. Rudkin, GE, Rudkin, AK, Dracopoulos, GC. Bilateral ankle blocks: a prospective audit. ANZ journal of surgery. 2005;75(1 2):39-42. 18. Sinardi, D, Marino, A, Chillemi, S, Siliotti, R, Mondello, E. Sciatic nerve block with lateral popliteal approach for hallux vagus correction. Comparison between 0.5% bupivacaine and 0.75% ropivacaine. Minerva Anestesiol. 2004;70(9):625-629. 19. Song, JH, Kang, C, Hwang, DS, Hwang, JM, Shin, BK. Fentanyl Patches to Supplement Ultrasound-Guided Nerve Blocks for Improving Pain Control After Foot and Ankle Surgery: A Prospective Study. J Foot Ankle Surg. 2016;55(1):121-124. doi:10.1053/j.jfas.2015.08.009.