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Ultrasound-Guided Multiple Peripheral Nerve Blocks in a Superobese Patient

DOI: 10.1155/2014/896914

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The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190?kg, 180?cm, BMI: 58?kg/m2) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2?cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients. 1. Introduction The number of obese patients is gradually increasing worldwide. The World Health Organization estimates that, by 2015, there will be 2.3 billion overweight (BMI 25–30?kg/m2) and 700 million obese (BMI > 30?kg/m2) adults worldwide [1]. Anatomic and physiological alterations occur in association with obesity, particularly in the airway and in the cardiovascular, respiratory, gastrointestinal, and neurological organ systems. These changes increase the incidence of comorbidities and cause limitations and problems in anesthesiology procedures [2]. For obese patients, regional anesthesia provides many advantages compared to general anesthesia, such as avoiding airway manipulation and systemic effects of anesthetic agents, and provides better postoperative pain control [3]. However, the failure rate increases in regional anesthesia procedures performed in obese patients due to the increased depth of nerve structures, the disappearance of landmarks, and difficulties in positioning [4]. On the other hand, the increase in the use of ultrasonography in recent years eliminates many limitations. Ultrasonography enables direct visualization of nerve structures, reduction in complications, and identification of new peripheral nerve block approaches [5]. In this study, we aimed to

References

[1]  World Health Organization, “Obesity,” 2008, http://www.who.int/topics/obesity/en/.
[2]  Y. Leykin, T. Pellis, E. Del Mestro, B. Marzano, G. Fanti, and J. B. Brodsky, “Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: hospital course and outcomes,” Obesity Surgery, vol. 16, no. 12, pp. 1563–1569, 2006.
[3]  J. Ingrande, J. B. Brodsky, and H. J. M. Lemmens, “Regional anesthesia and obesity,” Current Opinion in Anaesthesiology, vol. 22, no. 5, pp. 683–686, 2009.
[4]  M. C. Parra and R. W. Loftus, “Obesity and regional anesthesia,” International Anesthesiology Clinics, vol. 51, pp. 90–112, 2013.
[5]  Z. J. Koscielniak-Nielsen, “Ultrasound-guided peripheral nerve blocks: what are the benefits?” Acta Anaesthesiologica Scandinavica, vol. 52, no. 6, pp. 727–737, 2008.
[6]  R. J. Garrison and W. P. Castelli, “Weight and thirty-year mortality of men in the Framingham Study,” Annals of Internal Medicine, vol. 103, no. 6, pp. 1006–1009, 1985.
[7]  J. P. Adams and P. G. Murphy, “Obesity in anaesthesia and intensive care,” British Journal of Anaesthesia, vol. 85, no. 1, pp. 91–108, 2000.
[8]  Z. Shenkman, Y. Shir, and J. B. Brodsky, “Perioperative management of the obese patient,” British Journal of Anaesthesia, vol. 70, no. 3, pp. 349–359, 1993.
[9]  R. J. Whitty, C. V. Maxwell, and J. C. A. Carvalho, “Complications of neuraxial anesthesia in an extreme morbidly obese patient for cesarean section,” International Journal of Obstetric Anesthesia, vol. 16, no. 2, pp. 139–144, 2007.
[10]  K. J. Chin, A. Perlas, V. W. S. Chan, and R. Brull, “Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions,” Regional Anesthesia and Pain Medicine, vol. 33, no. 6, pp. 532–544, 2008.
[11]  P. H. Ting, J. G. Antonakakis, and D. C. Scalzo, “Ultrasound-guided common peroneal nerve block at the level of the fibular head,” Journal of Clinical Anesthesia, vol. 24, no. 2, pp. 145–147, 2012.
[12]  W. Ryan, N. Mahony, M. Delaney, M. O'Brien, and P. Murray, “Relationship of the common peroneal nerve and its branches to the head and neck of the fibula,” Clinical Anatomy, vol. 16, no. 6, pp. 501–505, 2003.
[13]  S. Carty and B. Nicholls, “Ultrasound-guided regional anaesthesia,” Continuing Education in Anaesthesia, Critical Care and Pain, vol. 7, no. 1, pp. 20–24, 2007.

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