Direct application of ropivacaine-soaked gauze to sciatic nerve after necrotizing fasciitis exposes underlying muscles and nerves.

Background: Necrotizing fasciitis is a rapidly progressive infection of the subcutaneous tissue and fascia with significant morbidity and mortality. There is a paucity of literature published on the benefits of regional anaesthesia in patients with necrotizing fasciitis of the extremities. Case Presentation: This study demonstrates novel approaches to management of pain in a patient with necrotizing fasciitis of the lower extremity. A 47-year-old male with polysubstance use disorder was found to have necrotizing fasciitis of the lower extremity. Surgical debridement included 15% of his total body surface area and resultant exposure of his sciatic nerve. A ropivacaine-soaked gauze was applied directly to the exposed sciatic nerve. Femoral and lateral cutaneous nerve blocks were performed to facilitate necessary surgical dressing changes and physical therapy.
Conclusion: This report details techniques used in postoperative pain management to facilitate surgical dressing changes after extensive debridement of an extremity for necrotizing fasciitis. The use of local anaesthetic-soaked gauze may be a useful adjunct in certain scenarios. © The British Pain Society 2021.