Parasacral ischial plane block for lower limb surgeries: A case series

The para-sacral ischial plane block (PIP block) is a novel fascial plane approach targeting the sacral plexus. This technique simplifies the process as direct visualization of the sacral plexus or sciatic nerve is unnecessary. This retrospective case series includes ten patients with American Society of Anesthesiologists (ASA) physical status II-IV, aged over 18 years, undergoing elective or emergency lower limb surgeries such as debridement and below-knee amputation between May 2023 and November 2023. The block was performed in ≤ 6 minutes for all patients. Onset of subjective analgesia was almost immediate in those presenting with pain. Sensory loss occurred within 9 to 12 minutes. Motor block in the sciatic nerve distribution did not reach Grade 2 in any patient. Hemodynamic stability was notably maintained in all high-risk cases. Intraoperative supplementation with ketamine was required for one patient. The PIP block is a quick, easy-to-perform technique that offers satisfactory surgical conditions and hemodynamic stability in high-risk patients undergoing lower limb surgeries. It also provides prolonged postoperative analgesia and early resumption of oral intake with minimal procedural discomfort.