Ankle Surgery in a Patient with Acute Subdural Hematoma Under Combined Lumbar Plexus and Proximal Sciatic Nerve Block – A Case Report

Utsav Acharya, Ritesh Lamsal Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, NepalCorrespondence: Utsav AcharyaDepartment of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu 44600, NepalTel +977 9843613683Fax +977 14473059Email utsav.ach@gmail.comAbstract: Acute subdural hematoma (aSDH) is commonly encountered in the emergency department in patients with traumatic injuries. If the hematoma is small, non-expanding and asymptomatic, it is managed conservatively. However, other injuries sustained during trauma may warrant surgical intervention, during which anesthetic management becomes challenging. There have been reports of rebleeding in patients with aSDH after undergoing surgery under either general or spinal anesthesia. Here we present a case where ankle surgery for tri-malleolar fracture was successfully performed in a patient with traumatic aSDH under combined lumbar plexus and proximal (para-sacral) sciatic nerve block.Keywords: intracranial hemorrhage, regional anesthesia, traumatic brain injury, ultrasound