与导管FICB

FICB with catheter

ANAESTHESIA IN DVT LIMB :
No comorbid , 50yrs male worker with trochenter fracture posted for DHS : 16 days back one vehicle hit him from back side and now coming to us with DVT of that limb . Diagnosis was done from symptoms and sign , swollen limb,pitting oedema and local rise of temperature : other limb OK : put on aspirin 150mg daily and LMWH 40mg BD : Economically very poor and insisting for surgery as early as possible as our setup is private : but I m postponding ! Am I justifiable ? If so how many days I have to wait? When to decide for surgery ?
Two days after admission in our hospital, pt had some abnormal behaviour with GCS E3 : CT showed Lacunar infarct : further postponed by Surgical team and attendant : Written informed consent with all possibilities was taken with Surgeon/staff nurse as witness and proceeded for surgery after 4 days of infarct with Nerve blocks and Spontaneous iGel GA.HOPE FOR THE BEST and same time PREPARING FOR WORST.
As pt requested for catheter , FICB catheter was inserted.
IN OPERATION THEATRE :
We are getting Fascia Iliaca Compartment at around 3.5-3.6 cm from skin. We are using REUSED Epidural needle and LOR syringe.Only patient have to purchase the catheter.You may notice some blood stained fluid in the epidural needle hub , donot worry , needle is not in the blood vessel, which has been checked ! Compartment was expanded with 35ml of 0.25% LevoBupivacaine, before inserting the catheter.

He was planned for DHS : After assessment of Block , patient was put on ortho table,reduction was done and when surgeon went for washing,patient was induced with Propofol 100mg and iGel inserted and maintained with oxygen,N2O and Dex infusion @0.6ml/Kg : well tolerated.

There was blood loss(expected) and 1 unit of Blood intraop : have to TOP UP FICB Catheter once ( Surgery took 3.8hr,as presumed by us),really a very bad fracture pattern.
At the end paracetamol 100ml and FICB infusion of 0.125% levoBupivacaine @4ml/hr.
Almost 24hrs now, patient stable.Till now everything is fine by THE GRACE OF THE GOD.