Combined Supra-Inguinal Fascia Iliaca, Sciatic Nerve, and Posterior Femoral Cutaneous Nerve Blocks in Austere Settings for Hemodynamically Unstable Patients with Vascular Injuries from Weapon Wounds: A Case Series

Abstract

Majaliwa Shabani,1,* Seydina Alioune Beye,2,* Abdoulaye Traore,3,* Xavier Raingeval,4,* Daouda Coulibaly,5,* Sophie Crespo6,* 1Health_Unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée, Paris, France; 5Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 6Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of Red Cross (ICRC), Rue 239, Hamdallaye /ACI2000 – B.P. 58, Bamako, Mali, Email [email protected]: The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique—sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks —in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.Patients and Methods: Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.Results: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.Conclusion: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.Keywords: war surgery, posterior femoral cutaneous nerve block, anesthesia in austere environments

Keywords

• war surgery
• posterior femoral cutaneous nerve block
• anesthesia in austere environments.