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94: Intraoperative Measurements of Distance Between Greater Trochanter and Sciatic Nerve; Implication to Hashem′s Approach to Sciatic Nerve Block
Posters
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Peripheral Nerve Blocks
75
94. Intraoperative measurements of distance between greater trochanter and sciatic nerve; implication to hashem⬘s approach to sciatic nerve block
107. Nurse-led preoperative femoral nerve block service for patients with fractured neck of femur - a 1 year pilot study
M. Hashem1, S. Isopescu2 1Withybush, Aanaesthesia, Haverdfordwest, UK, 2Withybush, Orthopaedics, Haverdfordwest, UK
M. Layzell1, B. Newman2, P. Cameron3, K. Horn3 1Poole Hospital NHS FoundationTrust and Bournemouth University, Acute Pain, Poole, UK, 2Poole Hospital NHS FoundationTrust, Anaesthetics, Poole, UK, 3Poole Hospital NHS FoundationTrust, Acute Pain, Poole, UK
Background and Aims: Sciatic nerve block (SNB) is frequently used for anaesthesia or analgesia during lower limb surgery. Although, there are several approaches for SNB, and sciatic nerve is the largest peripheral nerve, still many anaesthetists find it difficult to locate or to block mainly because of the deep location. The aim of this study is to measure the distance between the highest point of greater trochanter and sciatic nerve in the lateral position during surgery for hip replacement, and to find out if it could correlate with Hashems’ approach to sciatic nerve block as previously described. Methods: In this prospective observational study, 12 males and 15 females were included. After giving spinal or general anaesthesia patient was placed in the lateral recumbent position, with the leg to be blocked uppermost. The other leg is extended. The upper leg is bent approx. 30-40° at the hip joint and approximately 90° at the knee joint. The orthopaedic author who usually perform his hip replacement in the lateral position, measured the distance of sciatic nerve from the highest point of greater trochanter in perpendicular vertical plane. Results: The mean distance between sciatic nerve and the highest point of greater trochanter was 6.53 cm in females and 7.9 cm in males. That corresponded to distance used to perform sciatic nerve blockade at that position by the main author. Results are shown (table 1). Conclusions: The distance between sciatic nerve and the highest point of greater trochanter in the lateral position is predictable and can be reliably used as a landmark to block the sciatic nerve.
BMI
Age
Distance from GT (cm)
Distance operator’ fingers
Patients
Weight; kg.
Mean (SD), Females Mean (SD), Males
67 (15.4)
25.7 (5.11)
64 (17) 6.53 (0.667)
3.38 (0.416)
79.6 (9.19)
26.2 (1.99)
60.8 (12) 7.94 (0.464)
3.70 (0.447)
Background and Aims: The safety and utility of regional nerve blocks for the relief of trauma and postoperative pain are well established, and a femoral nerve block is a recognised safe technique which is easy to learn. This one year pilot study looks at the effectiveness and safety of specialist acute pain nurses performing femoral nerve blocks preoperatively for patients admitted to hospital with a fractured neck of femur. Method: Nurses were trained in taking consent and performing the block using stimuplex needles and a nerve stimulator. All patients admitted to hospital with a diagnosed fractured neck of femur, who do not have exclusion criteria, and surgery is delayed for more than 6 hours are offered a femoral nerve block. Outcomes are measured by linear analogue pain scores (in those patients capable) and measurement of passive hip flexion before and 2 hours after the block. In addition analgesic requirements 8 hours pre and post block are recorded. Results: Over 300 blocks have been performed with no adverse events. Of those, over 30% were not able to provide informed consent and verbal pain scores. On average patients reported a pain score reduction of 3 points on a 10 point verbal pain scale and an average increase of 25 degrees in passive hip flexion. Qualitative data from nursing and medical staff indicates that patients appear in less pain and they are able to move in bed more easily for nursing duties and to sit up to eat. Conclusion: We have established that the service can be provided by trained nurses, and the benefits are a significant reduction in the use of systemic analgesia and their associated adverse effects. In addition this procedure provides good pain relief and we have noted marked improvements in mood, co-operation in nursing care, nutrition and sleep patterns.
•
Peripheral Nerve Blocks
75
94. Intraoperative measurements of distance between greater trochanter and sciatic nerve; implication to hashem⬘s approach to sciatic nerve block
107. Nurse-led preoperative femoral nerve block service for patients with fractured neck of femur - a 1 year pilot study
M. Hashem1, S. Isopescu2 1Withybush, Aanaesthesia, Haverdfordwest, UK, 2Withybush, Orthopaedics, Haverdfordwest, UK
M. Layzell1, B. Newman2, P. Cameron3, K. Horn3 1Poole Hospital NHS FoundationTrust and Bournemouth University, Acute Pain, Poole, UK, 2Poole Hospital NHS FoundationTrust, Anaesthetics, Poole, UK, 3Poole Hospital NHS FoundationTrust, Acute Pain, Poole, UK
Background and Aims: Sciatic nerve block (SNB) is frequently used for anaesthesia or analgesia during lower limb surgery. Although, there are several approaches for SNB, and sciatic nerve is the largest peripheral nerve, still many anaesthetists find it difficult to locate or to block mainly because of the deep location. The aim of this study is to measure the distance between the highest point of greater trochanter and sciatic nerve in the lateral position during surgery for hip replacement, and to find out if it could correlate with Hashems’ approach to sciatic nerve block as previously described. Methods: In this prospective observational study, 12 males and 15 females were included. After giving spinal or general anaesthesia patient was placed in the lateral recumbent position, with the leg to be blocked uppermost. The other leg is extended. The upper leg is bent approx. 30-40° at the hip joint and approximately 90° at the knee joint. The orthopaedic author who usually perform his hip replacement in the lateral position, measured the distance of sciatic nerve from the highest point of greater trochanter in perpendicular vertical plane. Results: The mean distance between sciatic nerve and the highest point of greater trochanter was 6.53 cm in females and 7.9 cm in males. That corresponded to distance used to perform sciatic nerve blockade at that position by the main author. Results are shown (table 1). Conclusions: The distance between sciatic nerve and the highest point of greater trochanter in the lateral position is predictable and can be reliably used as a landmark to block the sciatic nerve.
BMI
Age
Distance from GT (cm)
Distance operator’ fingers
Patients
Weight; kg.
Mean (SD), Females Mean (SD), Males
67 (15.4)
25.7 (5.11)
64 (17) 6.53 (0.667)
3.38 (0.416)
79.6 (9.19)
26.2 (1.99)
60.8 (12) 7.94 (0.464)
3.70 (0.447)
Background and Aims: The safety and utility of regional nerve blocks for the relief of trauma and postoperative pain are well established, and a femoral nerve block is a recognised safe technique which is easy to learn. This one year pilot study looks at the effectiveness and safety of specialist acute pain nurses performing femoral nerve blocks preoperatively for patients admitted to hospital with a fractured neck of femur. Method: Nurses were trained in taking consent and performing the block using stimuplex needles and a nerve stimulator. All patients admitted to hospital with a diagnosed fractured neck of femur, who do not have exclusion criteria, and surgery is delayed for more than 6 hours are offered a femoral nerve block. Outcomes are measured by linear analogue pain scores (in those patients capable) and measurement of passive hip flexion before and 2 hours after the block. In addition analgesic requirements 8 hours pre and post block are recorded. Results: Over 300 blocks have been performed with no adverse events. Of those, over 30% were not able to provide informed consent and verbal pain scores. On average patients reported a pain score reduction of 3 points on a 10 point verbal pain scale and an average increase of 25 degrees in passive hip flexion. Qualitative data from nursing and medical staff indicates that patients appear in less pain and they are able to move in bed more easily for nursing duties and to sit up to eat. Conclusion: We have established that the service can be provided by trained nurses, and the benefits are a significant reduction in the use of systemic analgesia and their associated adverse effects. In addition this procedure provides good pain relief and we have noted marked improvements in mood, co-operation in nursing care, nutrition and sleep patterns.