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Foot Surgery (foot + surgery)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
V. COMPÈRE
Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post-operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post-operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre-operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th,75th percentiles]. Results: A total of 400 patients were included in the study during a 2-year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications. [source]

Continuous sciatic block for leg and foot surgery in 160 children

PEDIATRIC ANESTHESIA, Issue 11 2005
LAKSHMI VAS MD
Summary Background:, The aim of this study was to assess the safety and efficacy of continuous sciatic block for lower limb surgery in children. Methods:, A total of 160 pediatric patients aged 4 months to 12 years weighing 3.5,50 kg, were given continuous sciatic block plus single shot 3-in-1 block for leg and foot surgery. After general anesthesia, the sciatic nerve was located by using loss of resistance to saline by the mid-thigh approach. An 18 gauge epidural needle was introduced at the junction of the proximal two-third with the distal one-third of a line extending from the apex of popliteal triangle to the midpoint of the line joining the greater trochanter and the ischial tuberosity. A 20 g catheter was threaded through the needle for 5,10 cm and 0.25% bupivacaine 0.75 ml·kg,1 was injected. A single shot 3-in-1 block was also given to facilitate the use of a tourniquet with 0.25% bupivacaine 0.25 ml. In 20 patients a nerve stimulator was used in addition to loss of resistance. The intraoperative sedation comprised propofol and ketamine infusions and 50% nitrous oxide in oxygen by LMA. Results:, Eight-two percent of patients showed no response to surgery; 14% patients showed some response to the medial incision over the ankle and needed additional bolus doses of ketamine and propofol. Block was considered to have failed in 4% who required an increase in propofol and ketamine infusions. A total of 154 patients had good postoperative pain relief for 72 h with continuous infusion of 0.05% bupivacaine. The other six were given oral codeine and diclofenac. There were no complications attributable to sciatic block in any patient. Conclusions:, Sciatic block with a single shot 3-in-1 block for tourniquet pain and light general anesthesia provides good intraoperative conditions for leg and foot surgery and adequate postoperative pain relief. Additional sedation to minimize the discomfort of a cast may be a consideration in the first 24 h. [source]

Numerical Simulation of the Application of NiTi Alloys in Medical Technologies

PROCEEDINGS IN APPLIED MATHEMATICS & MECHANICS, Issue 1 2005
Daniel Christ
Shape memory alloys are nowadays already established as a material which is able to solve exceptional tasks in practical applications. Particularly, its utilization in the field of medical technologies increases steadily. For example micro tools (staple, catheters) and implants (coronary stents) are made out of Nickel-Titanium well known as a basic shape memory alloy. Apart from the advantages like the avoidance of auxiliary components and joints in the system and to utilize the high volume specific work of shape memory alloys, NiTi alloys exhibit a good biocompatibility. This property is necessary with regard to either permanent or temporary implants. To optimize the use of NiTi alloys in the scope of medical technologies, the support of the development of applicable tools by numerical simulations is highly recommended. However the complex material behaviour containing a profoundly thermomechanical coupling poses indeed a big challenge to the material modeling and its implementation into a finite element code. Particularly, the material model proposed by Helm [1] proves to be a firm model containing the most common properties of shape memory alloys, as the pseudoelasticity, the shape memory effect and the two-way effect. In the present contribution the FE modelling of a medical staple used in foot surgery is presented by considering the model of Helm which was investigated by the authors to improve its performance in the finite element method [2]. The foot staple, produced by a group of members of the SFB 459 which is funded by the DFG, avails the shape memory effect to excite the desired clamping effect [3]. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]