145 A novel convenient way of performing medial approach to sciatic nerve block in supine position

Abstract

145 Figure 1 Abstract 144 Figure 1 Abstracts A76 Reg Anesth Pain Med 2021;70(Suppl 1):A1–A127 coright. on S etem er 6, 2021 by gest. P rocted by htt//rapm bm jcom / R eg A nsth P in M d: frst pulished as 10.136/rapm -221-E S R A .45 on 9 S etem er 221. D ow nladed fom medially, allowing greater surface area for spread of local anesthesia. Vascular structures were further from sciatic nerve, reducing the risk of intravascular injection of local anaesthesia. With tibial nerve approached first medially, risk of common peroneal nerve injury could be reduced compared to lateral approach. Conclusions Our proposed position for medial approach of sciatic nerve block saves positioning time, with greater surface area for spread of local anesthesia, likely reducing the risk of intravascular injection of local anaesthesia and common peroneal nerve injury. 146 ADDUCTOR CANAL BLOCK AND FEMORAL TRIANGLE BLOCK: COMPARISON OF TIME TO ACHIEVE DISCHARGE CRITERIA AND EVALUATION OF LOCAL ANESTHETIC SPREAD N Sakai*, C Taruishi, T Sudani. Daiyukai General Hospital, Ichinomiya, Japan 10.1136/rapm-2021-ESRA.146 Background and Aims The femoral triangle block (FTB) and adductor canal block (ACB) have become standard analgesia for total knee arthroplasty (TKA). We compared the anatomical difference and postoperative recovery between two blocks. Methods We randomly assigned 118 patients to the FTB or ACB group. Patients were given 10 mL of 0.25% levobupivacaine as FTB or ACB. FTB was defined as at the mid-thigh, and ACB at the apex of the femoral triangle. The primary outcome was to achieve the discharge criteria (pain control with oral analgesics, knee flexion >90°, and ambulatory rehabilitation). ACB would be noninferior to FTB if the 95% confidence interval of the two groups’ differences were closer to zero than -9 hours (margin). We compared the local anesthetic spread, straight leg raise (SLR), and other outcomes. Results The time to achieve discharge criteria was 56.3±17.3 hours in the ACB group and 56.2±18.4 hours in the FTB group, a difference of 0.1 hours (95% CI: -6.4–6.6 hours, p=0.97), establishing noninferiority. At one hour postoperatively, 48 of 60 patients in ACB and 40 of 58 patients in FTB were capable of SLR (Odds ratio:0.59, p=0.29), a nonsignificant difference. The distance between the two points was 5.1 (4.9–5.4) cm, and the spread of local anesthetics was 6.9 cm cephalad, 5.1 cm caudad. There were no differences in pain scores or other outcomes. Conclusions ACB was non-inferior to FTB in time to achieve discharge criteria. We must warn of the potential quadriceps weakness after local anesthetic injection because of the high cephalad spread. 147 ERECTOR ERECTOR SPINAE BLOCK FOR ANALGESIA IN A PATIENT HAVING UNDERGONE CLAM SHELL THORACOTOMYSPINAE BLOCK FOR ANALGESIA IN A PATIENT HAVING UNDERGONE CLAM SHELL