Eric Ly1, Sai Velamuri2, William Hickerson2, David M Hill3, Jay Desai2, Ban Tsui4, Michael Herr5, Jerry Jones6. 1. College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA. 2. Department of Plastic Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA. 3. Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, TN, USA. 4. Department of Anesthesiology, The Stanford University Medical Center, Stanford, CA, USA. 5. Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA. 6. Department of Anesthesiology, The University of Tennessee Health Science Center, Memphis, TN, USA.
Abstract
BACKGROUND: A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the 'LIM' block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. CASE: We present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries. CONCLUSIONS: The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patient at particular risk for both issues.
BACKGROUND: A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the 'LIM' block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. CASE: We present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries. CONCLUSIONS: The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patient at particular risk for both issues.
Authors: James P Rathmell; Christopher L Wu; Raymond S Sinatra; Jane C Ballantyne; Brian Ginsberg; Debra B Gordon; Spencer S Liu; Frederick M Perkins; Scott S Reuben; Richard W Rosenquist; Eugene R Viscusi Journal: Reg Anesth Pain Med Date: 2006 Jul-Aug Impact factor: 6.288
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Authors: V Compère; N Rey; O Baert; A Ouennich; V Fourdrinier; X Roussignol; R Beccari; B Dureuil Journal: Acta Anaesthesiol Scand Date: 2009-03 Impact factor: 2.105