[Combined sciatic/3-in-1 block in routine surgical care].

For decades it has been known that the combined sciatic and femoral nerve block could be used for operations on the leg. Nevertheless, it is used in very few hospitals as a routine method for surgical anesthesia and only few publications exist in this area. To highlight some practical aspects, we have produced a retrospective study of 660 cases of femoral and sciatic nerve blocks used exclusively for operating purposes. For all blocks we used a nerve stimulator. For the sciatic nerve we normally used the posterior approach. The femoral nerve was blocked in the "3 in 1" method of Winnie to include the obturator and lateral femoral cutaneous nerves as well. All patients had been premedicated (Table 3). In 67% we used bupivacaine 0.5%, in 29% prilocaine 1%, in 4% mixed agents, and in 5 cases mepivacaine 1.5%. We added epinephrine 1:400,000 in all cases except those with cardiac contraindications. The maximal dose was 80 ml or 9.76 mg/kg prilocaine and 105 ml or 7.72 mg/kg bupivacaine. Both doses were tolerated without complications. Applying strict criteria (Fig. 1 + 2), the overall failure rate was 17.7% (Table 1): depending on the anesthesiologist administering the block 7.1%-27.8% (Fig. 3) and on the type of operation 4.6%-42.3% (Table 2). The most important factor influencing the failure rate was the anesthesiologist. The individual failure rate of the first 30 blocks of each anesthesiologist (V30) was nearly equal to the overall individual failure rate (Fig. 3). The form and time of premedication and the extent of sedation did not influence the results.(ABSTRACT TRUNCATED AT 250 WORDS)