Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jan 1989
[Truncal anesthesia of the foot at the level of the ankle: an additional reference mark for the approach to the posterior tibial nerve].
Nerve trunk blocks at the ankle could be a most interesting technique of regional anaesthesia. Unfortunately the posterior tibial nerve is difficult to locate with the usual recommended anatomical landmarks (the tibialis posterior artery). The use of the flexor hallucis longus tendon as an additional landmark has been tested in 71 patients scheduled for surgery on the foot (emergency trauma surgery, amputations, ingrowing toe-nails, removal of bedsores, verrucas). ⋯ Anaesthesia was obtained in 10 +/- 3 min, lasting from 180 to 240 min. There were 88.7% excellent results (n = 63), with 7% fair (n = 5) and 4.2% bad (n = 3) results. Failure concerned 5 cases of tibial nerve block, often due to landmark difficulties (great toe previously amputated, significant ankle oedema, lack of operator experience) and, in 3 cases, forgetting to block a nerve involved.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Ann Fr Anesth Reanim · Jan 1989
[Lumbar epidural catheterization: estimation of the length of the inserted catheter].
A catheter in the epidural space can be the cause of various iatrogenic complications. In order to avoid leaving too great a length in the lumbar epidural space during epidural anaesthesia, graduated Tuohy needles can be used (Perifix), together with graduated epidural catheters. On the latter, a special marking shows that, when it reaches the needle hub, the catheter tip is at the needle bevel. ⋯ This distance, and therefore catheter length, can then be reduced to about 4 cm by carefully withdrawing the catheter. Some possible improvements of catheters and needles are discussed. Knowing exactly how much catheter is within the epidural space could be of particular importance whenever that space is uncommonly far from the patient's skin: obesity, oedema, use of the paramedian route or a very oblique angle of the needle in the sagittal plane.