Summary:
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 fossa was blocked via posterior approach by
injecting 20ml 0.5% bupivacaine (100mg). The difficulty
of the block performance, level of patient discomfort, block
performance time, onset of sensory and motor blocks, time in
hours to the first request for supplemental systemic analgesia
postoperatively, its total consumption for 24 hours
postoperatively and associated side effects were recorded in
each group.
Results: Statistically, it was found no significant differences
between the demographic characteristics as well as the
duration of surgery between the groups. The groups did differ
significantly in the difficulty of the block performance.
However, a longer duration for performing the block was
observed in the P group. The level of patient discomfort was
significantly lesser in the P group. The onset of complete
sensory block was significantly longer in the P group.
Hemodynamic profiles of our patients were found to be
remarkably stable throughout the intraoperative period. In
the P group, the time to first pain medication was significant
longer. Moreover, the total dosage of analgesics during the
first 24 hours postoperatively in group P was highly
significant lesser compared to the other groups.
Conclusion: Sciatic nerve block at the popliteal fossa is an
ideal alternative where it is preferable to avoid spinal
anesthesia for foot surgeries in haemodynamicaly unstable
patients.
Key Words: Sciatic nerve block, spinal anesthesia, foot surgery.
(J Bangladesh Coll Phys Surg 2019; 37: 181-185)
DOI: http://dx.doi.org/10.3329/jbcps.v37i4.43347