# Peripheral Nerve Blockade for Trimalleolar Ankle Fracture Surgery in a Third-Trimester Pregnancy: A Case Report

## TL;DR

A pregnant woman underwent ankle surgery using a nerve block to ensure safety for both her and the fetus.

## Contribution

This case report highlights the use of peripheral nerve blockade in a third-trimester pregnancy for trimalleolar ankle fracture surgery.

## Key findings

- Peripheral nerve blockade with moderate sedation was safely used for the surgery.
- Postoperative pain was effectively managed with paracetamol and tramadol.
- The approach minimized risks like pulmonary aspiration and hypotension.

## Abstract

Nonobstetric surgery of pregnant patients is a challenge and concern for nonobstetric anesthesiologists. The approach to the pregnant patient for nonobstetric surgery must be multidisciplinary, including an obstetrician, an anesthesiologist, and a surgeon. We present the case of a 21-year-old female patient, in the 37th week of pregnancy, who sustained a trimalleolar fracture of the ankle joint, which required surgical treatment. The operation was performed under peripheral nerve blockade with moderate sedation. For the popliteal sciatic block, 15 mL of 0.5% levobupivacaine and 10 mL of 1.3% lidocaine were administered. For the saphenous block, 10 ml of 0.5% levobupivacaine was given. Sedation was performed with intravenous boluses of propofol. Pre- and postoperative assessments included referral to the gynecology clinic, where fetal heart rate monitoring and uterine contractions were monitored. Postoperative pain was managed with 1 g of paracetamol intravenously every eight hours, and a single dose of 50 mg tramadol intravenously was given, eight hours after surgery, when the numeric rating scale (NRS) was 4. The primary aim was to ensure the safety of the mother and fetus. Peripheral nerve blockade reduces the neuroendocrine response to stress, reducing the need for opioids and systemic analgesics. Also, the risk of pulmonary aspiration, hypotension, and hypoxia is avoided. Well-planned anesthesia and postoperative analgesia are essential to protect the mother and fetus.