title: Ultrasound-guided multiple peripheral nerve blocks in a superobese patient.
abstract: 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/m(2)) 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.
authors.affiliation: Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Kilicaslan
authors.affiliation: Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Topal
authors.affiliation: Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Erol
authors.affiliation: Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Hale
authors.initials: H
authors.lastname: Borazan
authors.affiliation: Department of Orthopaedic Surgery, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Onur
authors.identifier: 0000-0002-7682-0537
authors.initials: O
authors.lastname: Bilge
authors.affiliation: Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey.
authors.forename: Seref
authors.initials: S
authors.lastname: Otelcioglu