Foot Surgery in A Patient with Concurrent Hemorrhagic Stroke Under Femorosciatic Nerve Block
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Date
2024-01-09
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Abstract
Background : The Stroke due to intracerebral hemorrhage (ICH) is associated with high
morbidity and mortality. Concurrent traumas such as crushing injury to extremities or chest
and abdominal trauma may demand surgical intervention. The anesthetic management of
extracranial surgery becomes challenging in the context of a concurrent intracranial lesion.
Peripheral nerve block for foot surgery in those patients offers some advantages but is
scarcely reported.
Case Illustration : A 63-year-old man presented with an open wound on his left foot due
to a grinding wheel injury 1 day before admission. The complaint was accompanied by
weakness of the right limbs and inability to speak. He had an ischemic stroke 1 year ago.
Motor assessment revealed right hemiparesis. Computed Tomography (CT) scan of the
head showed an ICH in the left lentiform nucleus area, old infarcts in the right lentiform
nucleus region, and multiple infarcts in the subcortical regions of the bilateral parietal
lobes. He was diagnosed with an open fracture of the left proximal phalanx of the middle
finger, a closed fracture of the left 4th metatarsal, 1st–4th digitorum tendon rupture of the
left foot, and recurrent stroke on the contralateral side due to intracerebral hemorrhage of
the left carotid system. The patient was classified as ASA III. He underwent tendon repair,
open reduction internal fixation (ORIF) with K wire, and debridement. Anesthesia was
done with femorosciatic block using bupivacaine 0.4%. The patient’s motor function was
restored eight hours after the procedure without complications.
Conclusion : Peripheral nerve block is a safe and effective anesthetic approach for patients
undergoing foot surgery with concurrent hemorrhagic stroke.
Keywords: Stroke, Intracerebral hemorrhage (ICH), Peripheral nerve block (PNB),
Femorosciatic block
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Keywords
Stroke, Intracerebral hemorrhage (ICH), Peripheral nerve block (PNB)