Triple Nerve Injection for Open Reduction and Internal Fixation of Fracture Tibia and Fibula - A Feasibility Study

Area of Science:

• Regional Anesthesia
• Ultrasound-Guided Procedures
• Orthopedic Surgery

Background:

• Anterior surgical approaches to femoral, obturator, and sciatic nerves are challenging.
• Surface landmarks for these nerve blocks have limited success.
• This study explores a novel ultrasound-guided technique for these nerves.

Purpose of the Study:

• To describe and assess the feasibility of a single-puncture, ultrasound-guided triple nerve injection (TNI) block.
• To evaluate the TNI block in patients undergoing bicondylar fixation for proximal tibia fractures.

Main Methods:

• A feasibility study involving 40 patients with proximal tibia fractures.
• A single-puncture technique targeting femoral, sciatic, and obturator nerves using ultrasound guidance.
• Injection of 40 mL of 0.2% ropivacaine distributed among the three nerve targets.

Main Results:

• Optimal spread visualized in 90% of blocks.
• Pain perception occurred around 12-13 hours post-injection.
• Time to rescue analgesia was approximately 12 hours.
• 10% of sciatic blocks showed inadequate diffusion.

Conclusions:

• The triple nerve injection (TNI) block is a feasible single-puncture technique.
• Ultrasound guidance allows satisfactory visualization of three fascial planes.
• The technique requires only a single needle redirection.