WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr. Ahmed Basim Qasim*, Prof. Iyad Abbas Salman, Dr. Eethar Adel Ismail

ABSTRACT

Background: Ultrasound-guided popliteal sciatic nerve blocks and femoral are useful adjuncts for below knee amputation limb also provide excellent analgesia for all major foot and ankle procedures. Using of the injection pressure monitoring device enhances the accuracy of the local anesthetic deposition in popliteal sciatic nerve blocks. Our hypothesis is that an intraneural injection is associated with higher pressures and an increase in the risk of neurologic injury as compared with perineural injection. Aim of the study: The injection pressure monitoring enhances accuracy of local anesthetic deposition in addition to the use of ultrasound during popliteal sciatic nerve blocks and to Prevention of an intraneural injection of a local anesthetic during peripheral nerve block is considered important to avoid neurologic injury. Methods: Fifty patients ASA class III_IV, age (30_80)years of either sex scheduled for elective surgery unilateral below knee amputation were randomly assigned to receive either sciatic nerve block using a popliteal approach In a lateral position received amount of LA (20 ml of bupivacaine (0.375%) with monitoring of the bupivacaine injection pressure by a disposable pressure manometer and the continuous ultrasound view monitoring pressure level and additional ultrasound guided femoral nerve block by 12 ml of bupivacaine (0.375%) to ensure sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration were recorded and intraoperatively PR, noninvasive mean BP,RR,ECG,SpO2 was monitored. Results: Regarding to the pressure of the injections monitoring , we noticed that in this study, the highest proportion of study patients recorded needle nerve contact (44%) ,needed low pressure <15 psi (38%) , while all Intrafascular injection (18%). Sensory Block three points scale of pin brick sensation to check sensory block before and after nerve block. In this study, we noticed that all patients were normal in both pre nerve block and 5 minutes after nerve block, (74%) of patients were normal and 26% was decrease pain after 10 minutes from nerve block, at 15 minutes from nerve block, most patients were showed decreased pain (86%). The highest proportion of study patients after 20 minutes from nerve block was showed decreased pain (70%), then after 25 minutes of nerve block, the highest proportion of patients didn’t show pain (88%). All patients were completely free from pain after 30 minutes of nerve block. Motor block duration lasted for ≥ 20 mints in (68.1%) of study patients and the mean duration of achievement of complete motor block was 20.21 ± 2.43 mints. Conclusions: High injection pressures at the onset of injection >15psi may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits. If these results are applicable to clinical practice, avoiding excessive injection pressure during nerve block administration may help to reduce the risk of neurologic injury. The injection pressure monitoring enhances the accuracy of local anesthetic deposition in addition to the use of ultrasound.

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