Falyar Christian R
is a Certified Registered Nurse Anesthetist at Great River Health System in Burlington, Iowa.
AANA J. 2019 Apr;87(2):110-113.
A 31-year-old man scheduled for a fifth metatarsal head resection secondary to osteomyelitis presented to the preoperative holding area for placement of an ultrasound-guided popliteal nerve block as part of a multimodal pain management plan. During the preoperative evaluation, a medical history of CharcotMarie-Tooth disease was noted. The patient had decreased range of motion and neuropathy in both lower extremities and required an assistive device when ambulating. Before placement of the block, a pre-procedure scan of the popliteal fossa revealed abnormal sonoanatomy of the distal sciatic nerve as well as the proximal tibial and common peroneal nerve branches. The surgeon was consulted regarding the ultrasonography findings, and the proposed block was abandoned. A field block proximal to the surgical site was performed under monitored anesthesia care, with an understanding that the case would convert to general anesthesia using a laryngeal mask airway if the procedure was not tolerated. The surgery was performed as planned without any difficulties, and the patient was transferred to the postanesthesia care unit. The postoperative course was uneventful, and the patient was discharged home.
一名31岁男性因骨髓炎计划进行第五跖骨头切除术，作为多模式疼痛管理计划的一部分，他被送至术前等候区准备接受超声引导下腘神经阻滞。术前评估时，发现该患者有夏科-马里-图思病病史。患者双下肢活动范围减小且存在神经病变，行走时需要辅助器械。在进行阻滞前，对腘窝进行的术前扫描显示坐骨神经远端以及胫神经和腓总神经近端分支的超声解剖结构异常。就超声检查结果咨询了外科医生后，放弃了拟行的阻滞。在麻醉监护下于手术部位近端进行了区域阻滞，并达成共识，如果患者无法耐受该操作，则改为使用喉罩气道进行全身麻醉。手术按计划顺利进行，患者被转至麻醉后护理单元。术后过程平稳，患者出院回家。
