Dario Cirillo

Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series

• Authors Details :  
• Antonio Coviello,  
• Carmine Iacovazzo,  
• Dario Cirillo,  
• Pasquale Diglio,  
• Alessio Bernasconi,  
• Andrea Cozzolino,  
• Antonio Izzo,  
• Annachiara Marra,  
• Giuseppe Servillo,  
• Maria Vargas

Journal title : Journal of Medical Case Reports

Publisher : Springer Science and Business Media LLC

Online ISSN : 1752-1947

Journal volume : 17

Journal issue : 1

320 Views Case Report

The gold standard anesthesiologic procedure for urgent femur fracture surgery is Spinal Anesthesia. It is not always feasible because of patients' severe comorbidities and difficulties in optimizing drug therapy in the appropriate time frame such as discontinuation of anticoagulant drugs. The use of four peripheral nerve blocks (tetra-block) can be a winning weapon when all seems lost. We present, in this case series, three Caucasian adult femur fractures (an 83-year-old woman, a 73-year-old man, and a 68-year-old woman) with different and major comorbidities (cardiac or circulatory disorders on anticoagulants therapy that were not discontinued on time; breast cancer and others) underwent the same anesthesiologic approach in the urgent setting. Ultrasound peripheral nerve blocks, that is femoral, lateral femoral cutaneous, obturator, and sciatic with parasacral approach were successfully performed in all patients who underwent intramedullary nailing for intertrochanteric fracture. We evaluated the adequacy of the anesthesia plane, postoperative pain control with the VAS scale, and the incidence of postoperative side effects. Four peripheral nerve blocks (Tetra-block) can be alternative anesthesiologic management in urgent settings, in patients where drug therapy cannot be optimized, as in antiplatelet and anticoagulant therapy.

Article DOI & Crossmark Data

DOI : https://doi.org/10.1186/s13256-023-04017-6

Article Subject Details

• Anaesthesia pain
• Anesthesia and critical care
• Anesthesiology
• Orthopaedics Surgery
• Pain medicine

Article Keywords Details

• Case series
• Femoral nerve block
• Lateral femoral cutaneous nerve block
• Locoregional anesthesia
• Obturator nerve block
• Sciatic nerve block

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Article References

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