title: [Femoral and sciatic nerve blocks for open reduction and internal fixation of a femoral condylar fracture in a patient with post-polio syndrome].
abstract: The post polio symdrome (PPS) refers to the development of delayed neuromuscular symptoms among survivors, years after the initial presentation of acute poliomyelitis. The symptoms of PPS vary widely and include flaccid palsy, muscle weakness, scoliosis, osteoarthritis, gait disturbance, sleep apnea syndrome (SAS), dysphagia, chronic lung dysfunction, and others. We report the successful combination of peripheral nerve blocks, femoral and sciatic nerve blocks, for surgery on the lower extremity in a patient with PPS. A 51-year-old man with continuous positive airway pressure therapy for restrictive ventilatory impairment due to scoliosis and SAS as part of the PPS was scheduled for open reduction and internal fixation (OR-IF) for a right femoral condylar fracture. Respiratory function tests demonstrated a vital capacity (VC) 1.41l (41% predicted). Arterial blood gas analysis on room air was; pH 7.376, PaCO2 55.0 mmHg, and PaO2 77.9 mmHg. With the patient in the supine position, ultrasound-guided right femoral nerve block in the infra-inguinal region was performed using 1.5% mepivacaine 10 ml and 0.75% ropivacaine 5 ml, followed by sciatic nerve block in the popliteal fossa using 1.5% mepivacaine 8 ml and 0.75% ropivacaine 4 ml in the prone position. OR-IF of the fractured femoral condyle was then successfully performed with propofol under spontaneous ventilation. Postoperatively, there were no adverse events; respiratory function was adequate, and his pain was within manageable bounds. Femoral and sciatic nerve blocks are safe and effective anesthetic methods for lower extremity surgery in patients with restrictive ventilatory impairment and hypercapnia due to scoliosis and SAS as PPS.
authors.affiliation: Department of Anesthesiology, Teikyo University School of Medicine, Tokyo 173-8605.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Nagaoka
authors.forename: Ju
authors.initials: J
authors.lastname: Mizuno
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ino
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Shigeho
authors.initials: S
authors.lastname: Morita
mesh_terms: D000577:Amides; D000772:Anesthesia, Local / Q000379:methods*; D005264:Femoral Fractures / Q000601:surgery*; D005267:Femoral Nerve; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008619:Mepivacaine; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D016262:Postpoliomyelitis Syndrome; D012131:Respiratory Insufficiency; D000077212:Ropivacaine; D012584:Sciatic Nerve; D012600:Scoliosis; D012891:Sleep Apnea Syndromes
chemical_list: D000577:Amides; D000077212:Ropivacaine; D008619:Mepivacaine