Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Anesthesiology
Volume 2014, Article ID 896914, 4 pages
http://dx.doi.org/10.1155/2014/896914
Case Report

Ultrasound-Guided Multiple Peripheral Nerve Blocks in a Superobese Patient

1Department of Anaesthesiology, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey
2Department of Orthopaedic Surgery, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey

Received 31 August 2013; Accepted 18 November 2013; Published 22 January 2014

Academic Editors: P. Michalek, C. Seefelder, D. A. Story, and E. A. Vandermeersch

Copyright © 2014 Alper Kilicaslan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190 kg, 180 cm, BMI: 58 kg/m2) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2 cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients.