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[Combined sciatic and inguinal paravascular nerve block: a valid alternative for arthroscopic knee surgery]
1Servicio de Anestesiología y Reanimación, Centro de Traumatología y Rehabilitación FREMAP, Majadahonda, Madrid. enrique_monzo@fremap.es
Objective:
To assess the effectiveness of a combined transgluteal sciatic and inguinal paravascular nerve block for arthroscopic knee surgery.
Material And Methods:
Prospective descriptive study of 88 patients scheduled for arthroscopic knee surgery. Using a nerve stimulator and a transgluteal approach, we infiltrated the sciatic nerve with 20 mL of 1.5% mepivacaine. Then, with the patient in supine position, we located the femoral nerve and inserted a plastic catheter into the descending inguinal canal, applying pressure near the tip, to inject 20 mL of 1% mepivacaine. We evaluated a) anesthetic effectiveness, b) tolerance of the pressure cuff, c) time in the intensive care recovery unit, and d) time until reversal of the block.
Results:
Anesthesia was efficacious for 89.77% of the patients: excellent for 54 patients (61.36%), good for 25 (28.41%), and insufficient for 9 (10.23%). The pressure cuff was well tolerated by 70 patients (79.54%) and caused discomfort for 18 (20.45%). Mean postoperative stay in the intensive care recovery unit was 19.05 (SD 8.11) minutes. Reversal took place at a mean 204.09 (SD 22.59) minutes for the sensory nerve block and at 223.45 (SD 20) minutes for the motor block.
Conclusions:
The combined sciatic and inguinal paravascular block is effective for arthroscopic knee surgery and offers an alternative when other anesthetic techniques cannot be used. Use of a pressure cuff may require complementary sedation.