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Forty patients with proximal tibia fractures planned for bicolumnar open reduction and plate fixation received 40 mL of 0.2% ropivacaine distributed among the nerve branches. Pain relief averaged at 12 hours medially and 13 hours laterally. Optimal fascial plane spread occurred in 90% of blocks; sciatic diffusion was inadequate in 10%.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/triple-nerve-injection-for-open-reduction-and-internal-fixation-of-fracture-tibia-and-fibula-a-feasibility-study/417337/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/triple-nerve-injection-for-open-reduction-and-internal-fixation-of-fracture-tibia-and-fibula-a-feasibility-study/417337.png","ImageObject",300,407,{"name":92,"@type":93},"CatatanPagi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the “triple nerve injection” (TNI) approach in this study?","Question",{"text":113,"@type":114},"TNI is a single-puncture, single-probe technique using real-time guidance to inject around the femoral, sciatic, and obturator nerve branches in the proximal thigh.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How was the local anesthetic prepared and administered?",{"text":118,"@type":114},"Forty milliliters of 0.2% ropivacaine were injected: 10 mL near the femoral nerve, 20 mL near the sciatic nerve, and 5 mL each between adductors targeting the anterior and posterior obturator divisions.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the key findings on spread and analgesia timing?",{"text":122,"@type":114},"An optimal spread was visualized in 90% of blocks; diffusion in 10% of sciatic blocks was inadequate. 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Kashibai Nawle Hospital, Pune, Maharashtra, India  \nAbstract  \nBackground: Targeting femoral, obturator, and sciatic nerves with an anterior approach is a daunting task. Surface landmarks have been described but with limited success. This feasibility study describes a single‑puncture approach to the three nerves in real time under the guidance of a curvilinear probe and investigates the feasibility in the proximal thigh for patients undergoing bicondylar fixation with fractures of the proximal tibia. Methods: Forty patients with fractures ofthe proximal tibia planned for a bicolumnar open reduction and fixation with a plate were recruited in this feasibility study. We named this unique approach the “triple nerve injection”(TNI) block. These blocks were injected with 40 mL of 0.2% ropivacaine injected in the vicinity of the branches of the femoral nerve (10 mL), the sciatic nerve (20 mL), and between the adductors targeting the anterior and posterior division of the obturator nerves (5 mL each). Results: The pain was perceived at a mean of the 12th h on the medial side as against a mean of the 13th h on the lateral aspect. The time to rescue analgesia was 12 h. An optimal spread was visualized in 90% of blocks, while the diffusion in 10% of sciatic blocks was inadequate. Conclusion: A TNI block facilitates a single‑puncture and a single‑probe placement technique enables a satisfactory visualization of three fascial planes, together with a single needle redirection.  \nKeywords: Femoral nerve, nerve block, obturator nerve, sciatic nerve, ultrasonography  \nIntroductIon  \nTibial plateau fractures are common fractures that constitute approximately 1% of all fractures. [1,2] These fractures are significant because of its intra‑articular nature and associated meniscal and medial collateral ligament tears. However, AO/ OTA type C or Schatzker type V and VI accounts for 35.8% of all tibial plateau fractures.[3] Open reductions and internal fixation for bicondylar tibial fractures with a medial and lateral incision have generally shown good functional results. [4,5] A meta‑analysis questioning the role of single versus dual plate concluded that the dual plate has the advantage of maintaining anatomic alignment compared to a single plate.[6] A study investigating patient’s expectancy following surgery on fractures ofthe proximal tibia committed that “pain relief”and “being able to walk” were the highest priorities.[7] The pain scores Numeric rating scale (NRS) were a mean of 4.5 following surgeries on the proximal tibia. However, the residual pain following surgeries on proximal tibia was at 47% and  \nReceived: 14‑12‑2023 Revised: 05‑03‑2024 Accepted: 04‑10‑2024 Available Online: 20‑06‑2025  \n\n| Access this article online |  |\n| --- | --- |\n| Quick Response Code:\u003Cbr>| Website:\u003Cbr>[https://journals.lww.com/jmut](https://journals.lww.com/jmut) |\n|  | DOI:\u003Cbr>10.4103/jmu.jmu_ 163_23 |\n\n77% in two separate studies.[8,9] A prospective study revealed tibial fractures that had an incidence of complex regional pain syndrome after surgery of 31%, with 33.3% treated with intramedullary nailing, 28.6% treated with screws, and 28.6% treated with external fixation.[10] A task force guideline recommends using a continuous catheter over a single shot when administering a nerve block. They report better pain control with a decreased chance of rebound pain often associated with lower extremity blocks. It is hypothesized that reduced postoperative pain may allow earlier mobilization, better ","cbCaiebYQ6yFcgIB","https://ap.wps.com/l/cbCaiebYQ6yFcgIB","pdf",1265393,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Introduction\n# Keywords\n# Abbreviations","[{\"question\":\"What is the “triple nerve injection” (TNI) approach in this study?\",\"answer\":\"TNI is a single-puncture, single-probe technique using real-time guidance to inject around the femoral, sciatic, and obturator nerve branches in the proximal thigh.\"},{\"question\":\"How was the local anesthetic prepared and administered?\",\"answer\":\"Forty milliliters of 0.2% ropivacaine were injected: 10 mL near the femoral nerve, 20 mL near the sciatic nerve, and 5 mL each between adductors targeting the anterior and posterior obturator divisions.\"},{\"question\":\"What were the key findings on spread and analgesia timing?\",\"answer\":\"An optimal spread was visualized in 90% of blocks; diffusion in 10% of sciatic blocks was inadequate. Pain perception occurred at a mean of 12 hours medially and 13 hours laterally, with rescue analgesia at 12 hours.\"}]","Triple Nerve Injection for Open Reduction and Internal Fixation of Fracture Tibia and Fibula - A Feasibility Study | PDF",1790608893,15]