A new, lateral, continuous, combined, femoral–sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

Luiz Eduardo Imbelloni,^1,2 Carlos Rava,^1,3 Marildo A Gouveia<sup>2

1</sup>Faculdade de Medicina Nova Esperança, ²Institute for Regional Anesthesia, ³Complexo Hospitalar de Mangabeira Governador Tarcisio Burity, João Pessoa, Brazil

Background: The prevalence of anterior knee pain following intramedullary tibial nail insertion is high. Continuous peripheral nerve blockade is an alternative method of pain control to opiods. This case illustrates the use of femoral nerve and sciatic nerve peripheral catheters with an elastomeric infusion pump for major intramedullary nailing surgery.
Case report: A 36-year-old male with fractures to the left leg bones presented for placement of an intramedullary nail under spinal anesthesia. At the end of the procedure, access to the lateral femoral and sciatic continuous nerve block was achieved by using a stimulator connected to a 110 mm 18G Tuohy needle. Postoperative analgesia was provided with a 40-hour infusion of 0.1% bupivacaine (400 mL) at a rate of 10 mL hour^-1 with an elastomeric pump. Anesthetic dispersion and contrast were investigated. The analog scale remained with scores below 3 during the 40 hours after surgery, and boluses were not necessary.
Conclusion: The use of a femoral and sciatic nerve peripheral catheter offered an alternative to conventional pain control. Continuous femoral–sciatic peripheral blockade via a skin puncture with an infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.

Keywords: local anesthetic, bupivacaine, continuous peripheral nerve block, orthopedic surgery, tibia, elastomeric pump