Blockade of the lower extremities find rather broad application in anesthesiology practice. Emergence and distribution of ultrasound in anesthesiology made practice of performance of regional blockade safer and also allowed to lower necessary doses of local anesthetics, having reduced system toxic effects of these drugs. When carrying out blockade under ultrasonography control the operator has an opportunity to directly visualize arrangement of a needle, to make injections directly to area of necessary anatomical structures. Now blockade of the lower extremities under control of ultrasound are widespread in traumatology and orthopedics, plastic surgery, in vascular surgery, at other lower extremity operations.
It should be noted that conduction anesthesia of the lower extremity is traditionally less widespread in comparison with blockade of top. It is connected first, with big technical difficulties when carrying out blockade of the lower extremity as it is required not just to enter anesthetic into a fascial case of a brachial plexus (as in a case from top), and to block separate nerves. Besides, widespread recently spinal, epidural anesthesia and their combination allows to anesthetize effectively in the majority of clinical situations the lower extremity technically the easiest way. At the same time, sometimes there is a need to separately block this or that area by means of conduction blockade, for example, when there are contraindications to neuroaxial blockade. Besides, distribution of ultrasound made blockade of separate nerves of the lower extremities technically simpler and evident.
Under ultrasonic examination can be executed: blockade of a femoral nerve and blockade of a sciatic nerve (at various levels).
Are necessary for carrying out blockade of nerves of the lower extremity: the device ultrasonography with the linear sensor, a neurostimulator, needles for carrying out blockade, connecting tubes (for connection of a needle with the syringe and ensuring its immovability when carrying out blockade), a sterile table, balls, napkins, special sterile sleeves for the sensor. Manipulation is carried out in strictly aseptic conditions, with observance of all rules of sterility.
Blockade of a femoral nerve is used at various lower extremity operations: interventions on a hip joint, a hip, a knee and an ankle joint. The patient for carrying out blockade is stacked in situation on spin. If the patient has a pot-belly, it is necessary to provide good access to inguinal area, having removed a stomach up and holding it by means of the assistant. The linear high-frequency sensor which is installed in inguinal area over an inguinal fold perpendicular to an axis of the lower extremity of the patient is used. It is necessary to visualize an ileal muscle and the hyper echoic femoral nerve and also a femoral artery and a femoral vein lying on it. The injection needs to be carried out before division of a femoral artery as below nerves are divided and to reach adequate anesthesia of a nerve it can be difficult. The needle is entered from the lateral party, in the medial direction, into the planes of an ultrasonic beam. The needle is carried out through an ileal muscle over a nerve and carry out administration of drug, monitoring its distribution. It is at the same time necessary to avoid an intraneural injection carefully. After administration of anesthetic the needle is carefully taken.
Blockade of a sciatic nerve as it was already noted, can be made at two levels: at the level of a buttock or in a popliteal space. "f blockade is used when carrying out interventions on a shin, foot, knee and talocrural joints.
At podjyagodichny access the patient lies on one side, the blocked leg is from above and is a little bent in coxofemoral and knee joints. The convex sensor is used that allows an ultrasonic beam to get more deeply. The sensor is placed on the line between a big spit of a femur and a sciatic hillock. The hyper echoic sciatic nerve is under a big gluteus. The needle is entered from the lateral party, into the area of a sciatic nerve enter necessary amount of anesthetic then the needle is taken.
If use access from a popliteal space, then the patient have on a stomach, or in edgewise position. The last situation is used if the patient sedirovan or is in an anesthesia. By means of the linear sensor located in popliteal area visualize a neurovascular bunch, including a hyper echoic sciatic nerve or its components. To visualize all nerve entirely, the sensor is moved on the lower extremity up. The needle is entered from the lateral party, carry out an injection of anesthetic and the needle is taken.