Ultrasound guided 4 in 1 block for managing postoperative pain in arthroscopic knee surgery

Parthasarathy Srinivasan,Harith Dagupatti,Balachander Saravanan

doi:10.4038/slja.v27i1.8376

Parthasarathy Srinivasan, Harith Dagupatti + Show 1 more

Open Access

https://doi.org/10.4038/slja.v27i1.8376

Copy DOI

Abstract

Surgeries of the knee are usually painful and managing postoperative pain is challenging. Various methods of analgesia are available. Epidural is considered as gold standard but after the advent of ultrasound, peripheral nerve blockade of the lower limb is gaining importance. A 50-year-old male patient posted for arthroscopic knee surgery, completed under spinal anaesthesia, was given four in one block using ultrasound. The point of entry of the needle was in lower thigh where the femoral artery dips down deep. 30ml of 0.25% bupivacaine was given in the space above it. Postoperatively, the time of first systemic analgesia was noted which was eight hours after full regression from spinal. Peripheral nerve blocks of the lower limb for knee surgeries usually target only the femoral component. Addressing the sciatic component with a single injection is a real challenge and we did it to block the four nerves with a single point injection. We conclude 4 in 1 block is useful as a postoperative analgesic technique in knee surgeries.

Highlights

Knee arthroscopy is one of the commonly performed orthopedic procedures with significant number of patients having moderate to severe pain affecting activity level and satisfaction.[1]
Analgesia after knee surgery can be provided by multiple nonsystemic non-opioid based methods, including local anaesthetic infiltration, peripheral nerve blockade, neuraxial procedures, and intra-articular injections
We describe a case report where a patient underwent knee arthroscopy and the postoperative pain was successfully managed with 4-in-1 block through a single injection point

Summary

Introduction

Knee arthroscopy is one of the commonly performed orthopedic procedures with significant number of patients having moderate to severe pain affecting activity level and satisfaction.[1]. The combination of the femoral nerve block with sciatic nerve block has provided adequate analgesia with lower consumption of perioperative opioids and rescue analgesia, for knee and below knee surgeries.[6] The superior efficacy of the combined adductor canal block with the sciatic nerve block comes with associated technical difficulties including positioning of patients differently for both the blocks.[7] Here we describe a case report where a patient underwent knee arthroscopy and the postoperative pain was successfully managed with 4-in-1 block through a single injection point. Case Report A 50-year-old male ASA I patient with knee pain diagnosed as having Left Knee Loose Bodies was posted for knee arthroscopy. The transducer was kept just above this point and 30ml of 0.25% bupivacaine was injected to spread around the artery and in a plane to push the sartorius up. (Figure 1)

Discussion

Conclusion