Anesthetic blocks: key to lower limb spasticity management in developing countries (Tunisia)
Prof Sameh GHROUBIa, Dr Wafa ELLEUCHa, Dr Samar ALILAa, Dr Saoussan MAHERSIa, Prof Mohamed Habib ELLEUCHa
a Service de Médecine Physique et de Réadaptation, CHU Habib Bourguiba, Sfax, Tunisie, et Unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax
Anesthetic blocks are used by many teams for assessing spasticity and its complications. However , this utilization is still restricted.
Our objective was to specify the interest of anesthetic blocks in therapeutic decision and management of spasticity in our country where conditions are limited.
Materials and methods:
A prospective study including 84 patients with spasticity in their lower limb. A clinical evaluation was made before and after the block with a determination of spasticity, a measurement of articular amplitudes, a quotation of voluntary control and a functional evaluation.
We did 108 blocks. The injected sites were dominated by the posterior tibial nerve (63 blocks). We noted a gain from one to three points in the score Aschworth and from 19 to 22° in the articular amplitudes. The results obtained allow optimal therapeutic orientation. Botulinum toxin was indicated in hamstrings in 2 cases, in adductors in 20 cases and in soleus and/or in gastrocnemius in 64 cases. Ten orthopedic surgical procedures were indicated. Neurotomy of the tibial nerve was performed in two cases. The results of the neurotomy 1 year after surgery were similar to that observed by the block.
The anesthetic blocks take still an important place in the assessment of spastic patient. In fact, they give us both a differential diagnosis (between spasticity and retraction) and an idea about prognosis (shows us the effect of an eventual definitive treatment for a short period of time). This will give us the opportunity to choose the least expensive means of therapy which can be available in our country. It allows us to take a new decisional diagram not only scientific but also adapted to our real situation.
Viel E et al. Prise en charge des spasticités douloureuses : pourquoi et comment utiliser les blocs locorégionaux ? Presse Med 2008:1793-801.
Keywords : Spasticity, Motor blocks, Evaluation, Therapeutic decision