Very nice. I prefer an anterior approach to both sciatic and femoral nerve blocks. The patient doesn't have to be turned, and you can use only one needle in some smaller patients.
Nice video, really appreciate this. Any need to block posterior cutaneous nerve of thigh, subgluteal approach cannot reliably cover it. What about obturator is it needed?
Larger volume for femoral covers LFCN. Obturator is important only for higher AKA. Import - do not complicate, you can always use a few ml of local for what is not blocked - safe than trying to block everything and wasting time and increasing the risk of LAST. KSS pricniple.
@@nysoravideo Not sure I'd agree with that logic. You're presenting an AKA under peripheral blocks, avoiding spinal and GA. Advocating extra volume for LFCN when you can target it easily, and it will absolutely be in the surgical area. Obturator may, or may not be involved, with significant variability. Why not save the volume (and thus dose of LA and risk of LA toxicity), and target the LFCN as well as the obturator. In these patients, i'd rather specific, targeted, low volume blocks, rather than leaving things to chance (spread via volume, or risking lack of obturator involvement).
KSS: stands for "Keep it Simple Stupid". It is not meant to be offensive, just to remind people that the more complicated you make something, the higher the risk of a failure occuring @@kamakshiguna298
If you block everything - it becomes complicated and difficult to reproduce. 1-2 ml of local bu the srugeon if the crucal nerve is an issue is no brainer! Greetings and thanks for watching!
This approach for scatic n block I think not enough it bypass posterior cutaneous n of the thigh you need to go more higher gluteal approach plus u need to block also lateral cutaneous n of the thigh and obturator
Why not wait few days and do spinal? With surgeon infiltrating sciatic nerve with bupi intraoperative. You would have extra days to better prepare your patiente.
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Hello! Is IT enough? What about obturator nerv and lateral cutaneus nerv??
I was thinking just about that! The lateral and medial sensory territory aspect of the tight
Without these two nerve block, cannot do AK amputation. Lumbar plexus block would be better.
@@subbur3788 Lumbar plexus requires a high skill and is high risk.
I few months ago I had to do it, I used femoral block and infragluteal sciatic block.... But i used lateral femorocutaneos Also..... It was enough
What about the obturator and LFCN?
Very nice. I prefer an anterior approach to both sciatic and femoral nerve blocks. The patient doesn't have to be turned, and you can use only one needle in some smaller patients.
It would be easier in a patient of this body frame.
I thought you also need to block the obturator and the latera cutaneous nerve of the thigh
What sedation do you give the patients for the block and for the procedure?
Can you give us some info about the percentage of the solution and the approximate quantity, please?
What about a one sided spinal? Do you think it's underutilized?
How about the tolerance of tourniquet pain during surgery??
Nice video, really appreciate this.
Any need to block posterior cutaneous nerve of thigh, subgluteal approach cannot reliably cover it. What about obturator is it needed?
Yes, ideally. Sometimes it is blocked with proximal sciatic. But a couple of cc of local will do, when a problem. Greetings and thanks for watching!
What about Lat femoral cut and obturator nerves block for such operation
Larger volume for femoral covers LFCN. Obturator is important only for higher AKA. Import - do not complicate, you can always use a few ml of local for what is not blocked - safe than trying to block everything and wasting time and increasing the risk of LAST. KSS pricniple.
What is KSS principle by the way?
@@nysoravideo Not sure I'd agree with that logic. You're presenting an AKA under peripheral blocks, avoiding spinal and GA. Advocating extra volume for LFCN when you can target it easily, and it will absolutely be in the surgical area. Obturator may, or may not be involved, with significant variability. Why not save the volume (and thus dose of LA and risk of LA toxicity), and target the LFCN as well as the obturator. In these patients, i'd rather specific, targeted, low volume blocks, rather than leaving things to chance (spread via volume, or risking lack of obturator involvement).
KSS: stands for "Keep it Simple Stupid". It is not meant to be offensive, just to remind people that the more complicated you make something, the higher the risk of a failure occuring
@@kamakshiguna298
Thank you for your videos, big fan of your work!
How long can the analgesia last with this combination?
Wonderfull, but one doubt, with that technique there is no need to block crural nerve????
If you block everything - it becomes complicated and difficult to reproduce. 1-2 ml of local bu the srugeon if the crucal nerve is an issue is no brainer! Greetings and thanks for watching!
@@nysoravideo thanks you for your answer 👍🏼👍🏼👍🏼👍🏼
Both my legs are amputated above the knee so much pain going through my foot I don't have a foot 🦶🏾
Thank you! Very well!
Glad it was helpful!
Is there any necessary for obturator block
Too complicated. 3 nerves blocks = more time, more discomfort. A few ml of local will do, when necessary. Greetings and thanks for watching!
Thanks
This approach for scatic n block I think not enough it bypass posterior cutaneous n of the thigh you need to go more higher gluteal approach plus u need to block also lateral cutaneous n of the thigh and obturator
Why not wait few days and do spinal? With surgeon infiltrating sciatic nerve with bupi intraoperative. You would have extra days to better prepare your patiente.
What if pt is in sepsis n we need to remove the septic foci
Severa cardiac conditions? Bro, its an APB…
Block sciatic nerve higher
Looks like NYSORA is drinking the exparel koolaid