PERINEURAL CATHETERIZATION VIA POPLITEAL SCIATIC NERVE BLOCK: A SAFER ALTERNATIVE TO GENERAL ANAESTHESIA IN PATIENTS WITH RAISED INTRACRANIAL PRESSURE UNDERGOING ORTHOPAEDIC FOOT SURGERIES– A CASE SERIES
Main Article Content
Keywords
Perineural catheterization , Sciatic nerve block, Raised intracranial pressure (ICP).
Abstract
Background:
Patients with a history of raised intracranial pressure (ICP) present significant anesthetic challenges during lower limb surgeries. General anesthesia risks cerebral hemodynamic instability, while neuraxial blocks are relatively contraindicated. In such scenarios, peripheral nerve blocks may offer a safer alternative.
Objective:
To describe a case series of eight patients with recent head injuries and crush injuries to the foot, who underwent orthopedic surgery using ultrasound-guided perineural catheterization of the sciatic nerve via the popliteal approach.
Methods:
This prospective observational case series was conducted at a tertiary trauma center. Eight patients with trimalleolar or complex foot fractures, all with a background of subarachnoid hemorrhage or extradural hematoma, underwent orthopedic fixation under continuous sciatic nerve block and intermittent femoral nerve block. Intraoperative hemodynamic stability, pain scores, and postoperative outcomes were evaluated.
Results:
All eight patients tolerated the procedure well, with stable intraoperative vitals and no need for conversion to general anesthesia. Postoperative pain was effectively managed with continuous perineural infusion, with all patients reporting low VAS scores (<3). No complications related to catheterization or neurological deterioration were observed.
Conclusion:
This case series demonstrates that ultrasound-guided perineural catheterization of the sciatic nerve is a viable and safe alternative to general or neuraxial anesthesia in high-risk patients with a history of raised ICP. It offers stable anesthesia, excellent analgesia, and minimal systemic impact in complex orthopedic foot surgeries.
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Dr. Durai Henry
Junior Resident at GMC Akola
Dr Nikhil Gite
Assistant Professor GMC Akola
Dr Sushma Muthineni
Junior Resident at GMC Akola
Dr Anam Baig
Junior Resident at GMC Akola
Dr Pravin Sapkal
Associate Professor GMC Akola