A Comparative Study of Sciatic Nerve Block for Leg and Foot Surgery in Elderly Patients with the Help of Nerve Locator vs Paraesthesia Elicitation Technique (original) (raw)

A Comparative Study of Clinical Effects of Spinal Bupivacaine Versus Sciatic-Femoral Nerve Block (Anterior Approach) in High Risk Geriatric Patient for Lower Limb Orthopaedic Procedures

Journal of Evolution of Medical and Dental Sciences, 2017

BACKGROUND Spinal anaesthesia is widely used for lower limb orthopaedic procedure in all age groups. The procedure is safe, but may lead to cardiovascular instability in high risk geriatric patient. Recently, sciatic-femoral nerve block is being used with satisfactory result. The aim of the study was to compare the onset and duration of sensory and motor blockade, intensity and duration of postoperative analgesia, intraoperative and postoperative haemodynamics in between two groups, one receiving spinal anaesthesia and the other sciatic-femoral block (Anterior approach) in high risk geriatric age group. MATERIALS AND METHODS A randomised single-blinded clinical study was done on 60 ASA II and III geriatric patients undergoing lower limb orthopaedic procedure. In Group A (n = 30) patients received spinal anaesthesia with 2.5 mL 0.5% hyperbaric bupivacaine and Group B (n = 30) patients received sciatic-femoral block (Anterior approach) with 30 mL and 20 mL 0.25% bupivacaine respectively with nerve locator. Onset and duration of sensory and motor block, duration of analgesia, intensity of analgesia by Visual Analogue Scale (VAS) and haemodynamics (Blood pressure, Heart rate) were recorded. Side effects if any were noted. RESULT Our study revealed later onset of both sensory and motor block, but prolonged duration of analgesia in sciatic-femoral block compared to spinal anaesthesia. The result was statistically significant. Sciatic-femoral nerve block group had stable haemodynamics compared to spinal anaesthesia group (p < 0.05). CONCLUSION To conclude combined sciatic-femoral nerve block (Anterior approach) is a better alternative to spinal anaesthesia in high risk geriatric patients for lower limb orthopaedic procedure.

Sciatic Nerve Block in Single Nerve Block Technique for Unilateral Foot Surgery - an Alternative to Spinal Anaesthesia

Journal of Bangladesh College of Physicians and Surgeons, 2019

Background: In lower extremity surgeries, central neuraxial block or peripheral regional anesthesia technique can be used, mainly in elderly patients. This study investigates the efficiency of spinal anesthesia and sciatic nerve block techniques in lower extremity surgery. Spinal anesthesia may impair hemodynamic stability; peripheral nerve blocks targeting the sciatic nerve may be a useful alternative. Objective: To compare Unilateral Spinal Anesthesia versus Popliteal Block in patients undergoing elective foot surgery to determine the method of better outcome. Patients and Methods: This randomized comparative study was carried out on fifty co-operative patients of both sexes who were scheduled for elective foot surgeries. According to the used method of regional anesthesia, patients were divided into: (S) group unilateral intrathecal block with low-dose (7.5mg) of hyperbaric bupivacaine plus intrathecal fentanyl (25 mcg) and (P) group in which the sciatic nerve at the popliteal fo...

Comparative Study between Combined Sciatic-Femoral Nerve Block, via a Single Skin Injection, and Spinal Block Anesthesia for Unilateral Surgery of the Lower Limb

Brazilian Journal of Anesthesiology, 2010

Background and objectives: Unilateral spinal anesthesia has advantages when used in outpatient basis. The objective of the present study was to compare unilateral spinal anesthesia with combined sciatic-femoral nerve block in unilateral orthopedic surgeries in outpatients. Methods: Sixty patients were randomly divided into two groups of 30 patients to receive 6 mg of hyperbaric or hypobaric bupivacaine (RQ group) in left lateral decubitus, or 800 mg of 1.6% lidocaine with epinephrine on sciatic and femoral nerves (CFI group) in dorsal decubitus. A 150-mm needle connected to a neurostimulator, inserted in the middle point between both classical approaches, was used for the nerve block, with the injection of 15 mL on the femoral nerve and 35 mL on the sciatic nerve. The time for the blockades and their duration were evaluated. After twenty minutes, patients were evaluated regarding the sensorial and motor blockades. Results: Time for performance of spinal anesthesia was substantially lower than for combined sciatic-femoral nerve block. Unilateral blockade was achieved in 90% of the patients in the RQ group, and 100% in the CFI group. Bradycardia or hypotension was not observed. Conclusions: This study concluded that combined sciatic-femoral nerve block is technically easy to perform and it can be an alternative for unilateral blockade of the lower limbs. Unilateral spinal anesthesia with low doses of bupivacaine resulted in shorter time to perform it, lower number of attempts, and earlier recovery than combined sciatic-femoral nerve block, but with the same efficacy.

Comparative study of anterior and posterior approaches for sciatic nerve block for lower limb and foot surgery in diabetic patients

IP innovative publication pvt. ltd, 2019

Introduction: Sciatic nerve block (SNB) is an established technique of anaesthesia for lower limb and foot surgeries. Although several approaches to SNB have been described not a single one is ideal in all respect. We aimed to compare commonly used two approaches to SNB to fin d out which one is better with regard to efficacy and patient satisfaction. Materials and Methods: Consented 60 diabetic patients of ASA grade II,III posted for foot and /or lower limb surgery were randomly allocated to receive SNB by either anterior (n=30) or posterior (n=30) approach. Blocks were performed utilizing peripheral nerve stimulator (PNS), with 25 ml of local anaesthetic mixture (10 ml of 2% lignocaine with adrenaline and 15 ml of 0.5% bupivacaine). Time taken to perform block with number of attempts required, onset of sensory and motor block, duration of analgesia were record ed and compared. We also had compared comfort level of the patients. Observations and Results: Out of 60 patients, 1of anterior and 2 of posterior approach es had failed block. Time taken to perform anterior approach was significantly less (p< 0.05) when compared to posterior approach. Patients were comfortable with anterior approach than that of posterior. Faster onset of sensory and motor block, and more duration of analgesia was observed with the posterior group but the difference was not statistically significant. Conclusion: Our study concluded that though efficacy of both the anterior and posterior approaches to block sciatic nerve was same, anterior approach is easier than posterior approach as it requires lesser time to perform and gives far better patient comfort.

A peripheral nerve stimulator guided popliteal sciatic nerve block combined with adductor canal block in lower leg surgery- A sole anesthetic technique

Indian Journal of Clinical Anaesthesia

In lower leg surgeries involving fractures of distal tibia, ankle surgeries, debridement and PVD surgeries choice of anesthesia is usually regional anesthesia. When these patients are associated with co-morbid cardio-respiratory problems then it will become challenge for anesthesiologist to maintain homeostasis with good surgical anesthesia. Ayukut urfalioglu suggested another alternative technique in the form of Adductor canal block plus Lateral approach popliteal sciatic block as good alternative for these surgeries with better Intra-operative Haemodynamic Stability, additional post-operative pain relief and less requirement of systemic analgesia post-operatively.In this prospective randomised controlled trial, we aim to explore the efficacy of Adductor canal block plus Popliteal Sciatic Block for Lower leg surgeries. Sixty patients (ASA I, II, III) undergoing lower limb surgeries were randomly allocated in 2 groups (30 patients in each group). In Group P patients received PNS gui...

Use of peripheral nerve blocks in lower limb surgery for a cardiac patient

International journal of applied research, 2016

Patients with bifascicular bundle branch block or left bundle branch block (LBBB) can progress into a complete heart block and are at a risk of sudden peri-operative death. Hence while administrating anesthesia, sudden hemodynamic changes such at hypotension or tachycardia are deleterious to such patients. This is where Peripheral Nerve Blocks (PNB) have become a valuable technique in providing anesthesia especially for limb surgeries. They provide good analgesia intra-operatively as well as postoperatively, are cost effective and are comfortable for the patient. They have been noted to be extremely useful in conduction defect patients. Here we report a patient with complete LBBB who underwent right tibia plating under femoral and anterior sciatic block.

Comparison of Efficacy and Safety of 0.5% Bupivacaine and 0.5% Ropivacaine for Combined Femoral Nerve Block and Sciatic Nerve Block (Anterior Approach): A randomized controlled trial

Introduction: Regional blocks are increasingly the preferred for a wide range of lower limb surgical procedures over spinal and epidural anesthesia. Various local anesthetic agents in different concentrations have been used for combined femoral and sciatic nerve block. But the existing evidence is inconclusive on the ideal anesthetic agent and its concentration. The available evidence on relative merits of different anesthetic agents in Indian Population is even limited. Objectives: To compare the safety, efficacy and hemodynamic parameters of 0.5% Bupivacaine and 0.5% Ropivacaine during combined femoral and sciatic nerve block. Materials and Method: The study was a randomized double-blind controlled trial of 36 subjects, randomly assigned to 0.5% Bupivacaine and 0.5% Ropivacaine groups. Subjects between 18 to 60 years belonging to ASA grade I and II, posted for various below knee lower limb procedure were included. Time is taken for onset of sensory and motor block, duration of sensory and motor block was compared across the study groups using independent sample t-test. The occurrence of complications and hemodynamic parameters also were compared. Results: In the current study, no statistically significant difference was observed in the time taken for onset of sensory block in either femoral nerve (13.39 and 13.69 minutes in Bupivacaine and Ropivacaine groups respectively, p value 0.39) or sciatic nerve (17.19 and 17.14 minutes, p value 0.89) The motor blockade took 21.28 and 21.64 minutes respectively in both the study groups (P value 0.53). In the current study, the duration of sensory block was slightly longer in Bupivacaine group, as compared to Ropivacaine group (933.67Vs 924.22, p value 0.19), but this difference was statistically not significant. The duration of motor block was significantly longer in Bupivacaine group (243.78 Vs 189.11, p value 0.001), as compared to Ropivacaine group. None of the study subjects in both the groups have reported any complications. There were no significant differences in hemodynamic parameters across the groups. Conclusions 1. Both sensory and Motor block onset time were similar with 0.5% Bupivacaine and Ropivacaine in combined femoral and sciatic nerve block. The duration of sensory block also was comparable across the two groups 2. Bupivacaine had comparatively longer duration of motor block, as compared to Ropivacaine group 3. There were no clinically or statistically significant differences in hemodynamic parameters