title: Echo-Guided Differential Popliteal Block in an Obese Patient With Intractable Painful Leg Ulcer for Early Discharge in Day Surgery.
abstract: Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain. Our aim was to ensure an optimal degree of analgesia and, at the same time, to save motor function in order to make early discharge possible. We used 15 mL ropivacaine 0.375% to obtain a differential block, taking advantage of sensitive fibers selectivity of ropivacaine. Surgical debridement was performed successfully. Our peripheral blockade was able to provide significantly prolonged analgesia without motor block that guaranteed a safe and early discharge according to the Post Anesthetic Discharge Scoring System. The satisfaction expressed by the patient and her comfort during the procedure support the choice of this approach for intractable painful ulcers of lower limb.
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Zampi
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Iacovazzo
authors.affiliation: University of Naples "Federico II", Naples, Italy tmmpagano@inwind.it.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pagano
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Buonanno
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Carlomagno
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Cianciulli
authors.affiliation: University of Naples "Federico II", Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Servillo
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D009407:Nerve Block / Q000379:methods*; D009765:Obesity / Q000150:complications*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: day surgery; differential block; pain management; venous ulcer