50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Supine Sciatic and Femoral Nerve Blocks For Trauma Patient With Severe Burns and Elevated ICP: A Novel Technique

Samuel T Belgique, MD, Elisa L Takelo, MD

INTRODUCTION

Trauma patients with severe burns and traumatic brain injuries (TBIs) present unique challenges in managing pain and preventing secondary neurological insults1. This report highlights the innovative use of supine peripheral nerve blocks to address pain management and intracranial pressure (ICP) control in a critical trauma patient with extensive burns and polytrauma.

MATERIALS & METHODS

As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per UNC-Chapel Hill policy. Patient informed consent was obtained for submission of this case report.

CASE SUMMARY

27-year-old male

Injury:

•Single-vehicle rollover with vehicle fire and prolonged extrication

•37% TBSA mixed partial/full-thickness burns (bilateral lower extremities)

•Multifocal subarachnoid hemorrhage, elevated ICP, bradycardia

Problem: Pain associated elevated ICP during dressing changes and patient movement.

Goal: Provide analgesia while avoiding exacerbation of elevated ICP.

Challenge: Patient was unable to be rolled to the side for a subgluteal block and remained supine.

Approach:

•Bilateral single-shot femoral and sciatic nerve blocks under ultrasound guidance in the supine position.

•Legs were propped up for sciatic nerve block for access to the posterior thigh proximal to the full-thickness burns where the best image of the sciatic nerve could be found2.

•Local anesthetic: 80 mL of 0.25% ropivacaine (30 mL per sciatic nerve, 10 mL per femoral nerve)

Outcomes:

•ICP monitoring: 6-25 mmHg within 24 hours post-block

•Pain control: Dressing changes and repositioning performed without significant ICP spikes

•Ultrasound images: Figures demonstrate block approach and sciatic nerve anatomy

KEY TAKEAWAYS

•Peripheral nerve blocks may effectively manage pain in trauma patients with severe burns and TBI.

•Supine approach enables safe sciatic nerve block administration when access is limited by extensive burns.

•This technique is a valuable adjunct in multidisciplinary trauma care and merits further exploration.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

SUPINE SCIATIC AND FEMORAL NERVE BLOCKS FOR TRAUMA PATIENT WITH SEVERE BURNS AND ELEVATED ICP: A NOVEL TECHNIQUE.

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