key: cord-1036681-b9stf398
authors: Kot, Pablo; Rubio-Haro, Ruben; Bordes-García, Clara; Ferrer-Gómez, Carolina; De Andrés, Jose
title: Meralgia paresthetica after pelvic fixation in a polytrauma patient
date: 2021-03-31
journal: Korean J Anesthesiol
DOI: 10.4097/kja.21065
sha: 77988b955b9e36fb5218dc32e27aa8c418c90031
doc_id: 1036681
cord_uid: b9stf398

nan

after the fracture had healed 56 days later. Admission to the ICU was prolonged, remaining sedated during the moments of greatest instability, and later, the patient was weaned from the ventilator, followed by progressive rehabilitation. During the last phase of admission, the patient reported severe pain with a numerical rating scale (NRS) of 8-9 that worsened with mobilization. The pain remained severe despite the treatment regimen with continuous infusion of oxycodone 8 mg/h, fentanyl 75 µg/h in patch, pregabalin 75 mg/12 h, and acetaminophen 1 g/8 h. On examination, the patient expressed localized pain on the outer face of the right thigh, from the iliac crest to the middle third of the thigh. The main suspicion was the lesion of the LFCN during the surgery for the placement and removal of the pelvic fixator (Fig. 1A) . The radiograph shows the pelvic fixator placed on the patient (Fig. 1B) .

The ultrasound-guided infiltration of the right femoral cutaneous nerve was performed (Fig. 1C ). Levo-bupivacaine 0.5% 10 mL and triamcinolone 40 mg were administered. One hour after the blockade, the patient presented an improvement of pain > 75%, shifting from NRS 9 to NRS 2. This improvement allowed the reduction of oxycodone from 8 to 6 mg/h at 1 h post-block, from 6 to 3 mg/h at 3 h post-block, from 3 to 1 mg/h at 6 h postblock, and then its final withdrawal 1 day later. The patient had stable pain relief, with an NRS score of 3 at 48 h after the LFCN block. The technique was repeated for four consecutive days. One week later, the patient's NRS score remained at 3. Pain control during the period between the blockade and discharge from the ICU kept the patient comfortable and helped to avoid the administration of high-dose opioids.

Ultrasound-guided regional analgesia techniques must be incorporated in the ICU care portfolio for the daily practice of anesthesiologists and intensive care physicians. They provide excellent pain control in several situations where high opioid doses are necessary, avoiding the side effects and dependence phenomena associated with opioids.

None.

No potential conflict of interest relevant to this article was reported. 

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