Advertisement

Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44)

      Abstract

      The present randomized controlled trial evaluated the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating the time required before surgery and the clinical results stratified by the anesthesia method (US-guided NB or general anesthesia [GA]). From June 2014 to April 2016, 40 patients who had undergone emergency surgery for external fixator application were enrolled in the present study. We measured the lead time before the start of surgery after the decision to perform emergency surgery in both groups. The US-guided NB group included 17 males (85%) and 3 females (15%), with a mean age of 55.6 (range 33 to 77) years. Of these 20 patients, 12 (60%) had comorbidities such as diabetes mellitus, hypertension, and kidney-related disease. Fracture type 42, 43, and 44 in the AO classification were observed in 3 (15%), 12 (60%), and 5 (25%) cases, respectively. The mean interval before emergency surgery was 4.3 (range 2 to 6.25) hours in the US-guided NB group. In the GA group (n = 20 patients), the mean interval before emergency surgery was 9.4 (range 3 to 14) hours, and this difference was statistically significant (p < .001). In the US-guided NB group, no cases of anesthesia failure or unstable vital signs occurred during surgery. Also, no postoperative complications related to the anesthesia method, such as aggravation of the general condition, developed. In contrast, 1 case of postoperative atelectasis occurred in the GA group. Emergency external fixation with US-guided NB in patients with lower extremity trauma can be implemented in less time, regardless of the preoperative preparation, which is a requirement for GA.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Byrd H.S.
        • Spicer T.E.
        • Cierney III, G.
        Management of open tibial fractures.
        Plast Reconstr Surg. 1985; 76: 719-728
        • Parrett B.M.
        • Matros E.
        • Pribaz J.J.
        • Orgill D.P.
        Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures.
        Plast Reconstr Surg. 2006; 117: 1315-1322
        • Rudkin G.E.
        • Rudkin A.K.
        • Dracopoulos G.C.
        Bilateral ankle blocks: a prospective audit.
        ANZ J Surg. 2005; 75: 39-42
        • Yang K.H.
        • Won Y.
        • Lim J.R.
        • Kang D.H.
        Assessment of Bosworth-type fracture by external oblique radiographs.
        Am J Emerg Med. 2014; 32: 1387-1390
        • Yang K.-H.
        • Won Y.
        • Kim S.B.
        • Park W.K.
        • Jung Y.S.
        Calcified anterior tibial artery entrapment in distal third tibial fracture: a case report.
        J Korean Fracture Soc. 2016; 29: 68-72
        • Egol K.A.
        • Tejwani N.C.
        • Capla E.L.
        • Wolinsky P.L.
        • Koval K.J.
        Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol.
        J Orthop Trauma. 2005; 19: 448-455
        • Myerson M.S.
        • Ruland C.M.
        • Allon S.M.
        Regional anesthesia for foot and ankle surgery.
        Foot Ankle Int. 1992; 13: 282-288
        • Domingo-Triadó V.
        • Selfa S.
        • Martínez F.
        • Sánchez-Contreras D.
        • Reche M.
        • Tecles J.
        • Crespo M.T.
        • Palanca J.M.
        • Moro B.
        Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective, comparative, randomized study.
        Anesth Analg. 2007; 104: 1270-1274
        • Kim Y.M.
        • Kang C.
        • Joo Y.B.
        • Yeon K.U.
        • Kang D.H.
        • Park I.Y.
        Usefulness of ultrasound-guided lower extremity nerve blockade in surgery for patellar fracture.
        Knee Surg Relat Res. 2015; 27: 108-116
        • Kim Y.M.
        • Joo Y.B.
        • Kang C.
        • Song J.H.
        Can ultrasound-guided nerve block be a useful method of anesthesia for arthroscopic knee surgery?.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2090-2096
        • Kim J.-W.
        • Oh C.-W.
        • Oh J.-K.
        • Kyung H.-S.
        • Min W.-K.
        • Park B.-C.
        • Kim K.-H.
        • Kim H.-J.
        Staged minimally invasive plate osteosynthesis of proximal tibial fracture.
        J Korean Fracture Soc. 2009; 22: 6-12
        • Song J.H.
        • Kang C.
        • Hwang D.S.
        • Hwang J.M.
        • Shin B.K.
        Fentanyl patches to supplement ultrasound-guided nerve blocks for improving pain control after foot and ankle surgery: a prospective study.
        J Foot Ankle Surg. 2016; 55: 121-124
        • Fredrickson M.J.
        • Kilfoyle D.H.
        Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study.
        Anaesthesia. 2009; 64: 836-844
        • Helayel P.E.
        • da Conceicao D.B.
        • Pavei P.
        • Knaesel J.A.
        • de Oliveira Filho G.R.
        Ultrasound-guided obturator nerve block: a preliminary report of a case series.
        Reg Anesth Pain Med. 2007; 32: 221-226
        • Marhofer P.
        • Greher M.
        • Kapral S.
        Ultrasound guidance in regional anaesthesia.
        Br J Anaesth. 2005; 94: 7-17
        • Casati A.
        • Borghi B.
        • Fanelli G.
        • Cerchierini E.
        • Santorsola R.
        • Sassoli V.
        • Grispigni C.
        • Torri G.
        A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block.
        Anesth Analg. 2002; 94: 987-990
        • Casati A.
        • Chelly J.E.
        • Cerchierini E.
        • Santorsola R.
        • Nobili F.
        • Grispigni C.
        • Di Benedetto P.
        • Torri G.
        Clinical properties of levobupivacaine or racemic bupivacaine for sciatic nerve block.
        J Clin Anesth. 2002; 14: 111-114
        • Fernández-Guisasola J.
        • Andueza A.
        • Burgos E.
        • Plaza A.
        • Porras M.
        • Reboto P.
        • Rivera J.
        • García Del Valle S.
        A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block in the popliteal fossa.
        Acta Anaesth Scand. 2001; 45: 967-970
        • Sinardi D.
        • Marino A.
        • Chillemi S.
        • Siliotti R.
        • Mondello E.
        Sciatic nerve block with lateral popliteal approach for hallux vagus correction: comparison between 0.5% bupivacaine and 0.75% ropivacaine.
        Minerva Anestesiol. 2004; 70: 625-629
        • Markham A.
        • Faulds D.
        Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia.
        Drugs. 1996; 52: 429-449
        • Ljungqvist O.
        • Søreide E.
        Preoperative fasting.
        Br J Surg. 2003; 90: 400-406
        • Jacobson E.
        • Forssblad M.
        • Rosenberg J.
        • Westman L.
        • Weidenhielm L.
        Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia.
        Arthroscopy. 2000; 16: 183-190