Combination of Regional Anesthetic Blocks for Femoropopliteal Bypass Surgery

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We have read with great interest the article by Basagan-Mogol et al1Basagan-Mogol E. Turker G. Yilmaz M. et al.Combination of a psoas compartment, sciatic nerve, and T12-L1 paravertebral blocks for femoropopliteal bypass surgery in a high-risk patient.J Cardiothorac Vasc Anesth. 2008; 22: 337-339Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar entitled “Combination of a Psoas Compartment, Sciatic Nerve, and T12-L1 Paravertebral Blocks for Femoropopliteal Bypass Surgery in a High-Risk Patient.” It is known that general anesthesia increases postoperative complications, and central neuraxial blocks may cause serious sympathetic block and hemodynamic side effects in high-risk patients. For these reasons, peripheral regional anesthesia is generally preferred in high-risk patients. Basagan-Mogol et al1Basagan-Mogol E. Turker G. Yilmaz M. et al.Combination of a psoas compartment, sciatic nerve, and T12-L1 paravertebral blocks for femoropopliteal bypass surgery in a high-risk patient.J Cardiothorac Vasc Anesth. 2008; 22: 337-339Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar used an anesthetic solution consisting of 0.33% bupivacaine with 1/200,000 epinephrine. Kocum et al2Kocum A. Turkoz A. Ulger H. et al.Ropivacaine 0.25% is as effective as bupivacaine 0.25% in providing surgical anaesthesia for lumbar plexus and sciatic nerve block in high-risk patients: Preliminary report.Anaesth Intensive Care. 2007; 35: 510-514PubMed Google Scholar compared the effectiveness of ropivacaine 0.25% and bupivacaine 0.25% for surgical anesthesia and postoperative analgesia during lumbar plexus and sciatic nerve block for high-risk patients with the same volume as the psoas block (30 mL) and the sciatic nerve block (20 mL). Bupivacaine is usually used at the minimum concentration (0.25%) required for surgical anesthesia to reduce the risk as much as possible.3Naja Z. el Hassan M.J. Khatib H. et al.Combined sciatic-paravertebral nerve block vs. general anaesthesia for fractured hip of the elderly.Middle East J Anesthesiol. 2000; 15: 559-568PubMed Google Scholar, 4Asao Y. Higuchi T. Tsubaki N. et al.Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in four patients with severe heart failure.Masui. 2005; 54: 648-652PubMed Google Scholar It has been previously reported that 0.25% bupivacaine can provide sufficient surgical anesthesia with combined lumbar plexus and sciatic nerve blocks.4Asao Y. Higuchi T. Tsubaki N. et al.Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in four patients with severe heart failure.Masui. 2005; 54: 648-652PubMed Google Scholar, 5Chudinov A. Berkenstadt H. Salai M. et al.Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures.Reg Anesth Pain Med. 1999; 24: 563-568Crossref PubMed Google Scholar We use this combination of regional techniques and the same concentration (0.25% bupivacaine) and also the same volumes for our high-risk patients undergoing femoropopliteal bypass surgery. In our experience, this technique achieves good patient and surgeon satisfication during and after the surgical period. We believe that bupivacaine 0.25% is a sufficient concentration and provides adequate analgesia and safe anesthesia for high-risk patients undergoing femoropopliteal bypass surgery. Combination of a Psoas Compartment, Sciatic Nerve, and T12-L1 Paravertebral Blocks for Femoropopliteal Bypass Surgery in a High-Risk PatientJournal of Cardiothoracic and Vascular AnesthesiaVol. 22Issue 2PreviewAn ideal anesthetic would provide good analgesia, have few complications associated with its use including minimizing hemodynamic instability, and provide an adequate surgical environment. It can be difficult to decide the type of anesthesia in high-risk vascular surgical patients. Although femoropopliteal bypass surgery is usually performed under general anesthesia or central nerve blocks, peripheral regional anesthesia could be a good choice especially in high-risk patients.1,2 We report a high-risk patient who presented for lower-limb revascularization with femoropopliteal bypass surgery. Full-Text PDF