Utama, Sigit Prasetya
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Adductor Canal Block (ACB) as an Adequate Analgesia Post Anterior Cruciate Ligament Repair Utama, Sigit Prasetya; Kuntoadi, Danang; Yuliana, Friskha
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.61865

Abstract

Background: Anterior cruriate ligament (ACL) injury is one of the most common cases in knee injury. Inadequate pain management will cause a decrease in quality of life, daily living abilities, increase hospitalization costs, and progressively causing chronic pain. Selection of inappropriate peripheral nerve block (PNB) can reduce range of movement ROM. Abductor canal block (ACB) is expected to facilitate adequate analgetic, improve early mobilization and ambulation, reduce the risk of post operative nausea vomiting (PONV), and needs for other analgeticsCase: A 21-year-old male patient with a diagnosis of ACL rupture knee (S) who will be performed anterior cruriate ligament recontruction (ACLR) procedure with physical status ASA II, premedication ondancentron 4 mg and dexamethasone 5 mg intravenously. Regional anesthesia subarachnoid block, at L3-L4 interspatium with bupivacaine hyperbaric 0.5% 15 mg and fentanyl 25 mcg as the adjuvant for subarachnoid block. Adductor canal block using ultrasound guide using 20 ml levo bupivacaine 0.25%. The outcome assessed using nurmmeric rating score (NRS), PONV, rescue analgetics, and ambulation score which includes: time up to go (TUG) with partial weight bearing, s-CST, 5xSST, 6 WMT straight leg raising (SLR) assessed at more than 48 hours.Discussion: PNB is proven to be reliable and effective for postoperative pain control, ambulation, rehabilitation and mobilization are also faster, adequate pain control will facilitate early mobilization and prevent side effects related to prolonged immobilization. Adductor canal block is a good modality as an adequate analgetic, the use of ACB can reduce use of rescue analgetic, reduce the incidence of PONV and support early mobilization.Conclusion: ACB in ACLR can facilitate adequate analgesia, does not require other rescue analgetics, reduce the incidence of PONV, and improve the ambulation as well as avoid other complications.
Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report Utama, Sigit Prasetya; Yuliana, Friskha; Kuntoadi, Danang
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.66116

Abstract

Background: Femur fractures are most common in geriatric patients, necessitating careful consideration of perioperative medications. Effective pain management is crucial to minimize neurohormonal stress responses. Reducing opioid use in older patients can prevent side effects and complications. The fascia iliaca compartment block (FICB) is a safe and efficient nerve block method, known to decrease opioid needs in hip surgery. It is anticipated to enhance mobilization speed and ambulation and reduce postoperative nausea, vomiting, deep vein thrombosis, and pneumonia, thereby improving overall outcomes for geriatric patients undergoing hip surgery.Case: A 71-year-old female with a closed right intertrochanteric femur fracture underwent open reduction and internal fixation with a proximal femoral nail antirotation. Classified as ASA II, geriatric, with stage I hypertension, her preoperative vital signs included a blood pressure of 170/95 mmHg, heart rate of 65 beats per minute, respiration rate of 20 times per minute, and SpO2 of 98% with nasal cannula oxygen at 3 lpm. Spinal anesthesia was administered at L3-L4, and an FICB was performed postoperatively. Pain assessment, rescue analgesic use, and postoperative nausea were evaluated post-surgery, with monitoring at 6, 24, and 48 hours.Discussion: Pain management with regional FICB anesthesia can simultaneously block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve. Thus, minimizing systemic symptoms compared to analgesics administered intravenously. In this case, the administration of 30 cc of levobupivacaine via a FICB provided effective analgesia for up to 72 hours post-blockade in a geriatric patient without causing side effects, such as postoperative nausea.Conclusion: Postoperative FICB for hip surgery in geriatric patients provides effective analgesia with minimal side effects.