Anesth Pain Med.  2022 Jan;17(1):87-92. 10.17085/apm.21029.

Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report -

• Ly E
• Velamuri S
• Hickerson W
• Hill DM
• Desai J
• Tsui B
• Herr M
• Jones J

• KMID: 2526532
• DOI: http://doi.org/10.17085/apm.21029

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.

Keyword

Acute pain service; Amputation; Analgesia; Anesthesia; Local anesthesia; Nerve block

Figure

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  Fig. 1. Lateral femoral cutaneous (LFC) nerve & local anesthetic in fat pad over fascia iliaca and iliopsoas muscle lateral to sartorius muscle with probe in transverse view (post-block).

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  Fig. 2. Lateral femoral cutaneous (LFC) nerve & local anesthetic in fat pad over fascia iliaca and iliopsoas muscle lateral to sartorius muscle with probe in near sagittal view (post-block).

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  Fig. 3. Local anesthetic & air seen tracking medially above sartorius muscle in near sagittal view (post-block).

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  Fig. 4. Anatomy of a ‘LIM’ (Lateral [LFC], Intermediate [IFC], and Medial [MFC] Femoral cutaneous nerves) block with ultrasound probe orientation and needle direction. Adapted from the Lewis and Gray (Anatomy of the human body, 1918) [5].

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