The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

2017 ◽  
Vol 30 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Hou Yee Lai ◽  
Li Lian Foo ◽  
Siu Min Lim ◽  
Chen Fei Yong ◽  
Pui San Loh ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Diabetic Foot ◽  
Peripheral Nerve Block ◽  
Diabetic Patients ◽  
Foot Surgery

scholarly journals Comparison of the Combined Femoral and Lateral Femoral Cutaneous Nerve Block Plus Popliteal Block with Spinal Anesthesia for Thigh Tourniquet Pain During Foot or Ankle Surgery: A Randomized Clinical Trial

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Shideh Dabir ◽  
Faramarz Mosaffa ◽  
Behnam Hosseini ◽  
Vahideh Alimoradi
Keyword(s):  
Peripheral Nerve ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Tourniquet Pain ◽  
Pain Scores ◽  
Femoral Cutaneous Nerve ◽  
Popliteal Block

Background: A pneumatic thigh tourniquet is routinely used during lower-extremity orthopedic surgeries to provide a bloodless field. When using peripheral nerve blocks, tourniquet-related thigh pain and discomfort limit their routine use as an anesthetic method. Objectives: The aim of the present prospective, randomized study was to compare the efficacy of combined femoral nerve/lateral femoral cutaneous nerve block technique and spinal anesthesia on intraoperative thigh tourniquet pain. Methods: We studied 60 American Society of Anesthesiologists physical status I-II patients scheduled for orthopedic surgery on the foot or ankle using a pneumatic thigh tourniquet. They were randomly divided into two equal groups. The peripheral nerve block group received a combined popliteal, femoral, and lateral femoral cutaneous nerve block under ultrasound-guidance. In both groups, the level of sensory blockade was determined by the pinprick test. The block performance time, anesthetic effect time, intraoperative tourniquet pain scores, the amount of fentanyl and ketamine, surgery duration, and patient’s satisfaction were recorded. Results: The patients’ characteristics were comparable in the two groups. The mean duration of block performance and anesthetic effect, intraoperative tourniquet pain scores, and the amount of intravenous analgesics in the peripheral nerve block group were significantly greater than those in the spinal anesthesia group. Patient satisfaction was similar in both groups. Conclusions: Spinal anesthesia is significantly more effective than the peripheral nerve block method in reducing thigh tourniquet pain. A combined femoral and lateral femoral cutaneous nerve block with popliteal block can improve thigh tourniquet tolerance if supplemented with intravenous analgesics.

scholarly journals Peripheral Nerve Block Versus Spinal Anesthesia for Total Knee Replacement in Elderly Patients

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Milovan Vukotic ◽  
Aleksandra Vukotic ◽  
Zoran Bascarevic ◽  
Nebojsa Videnovic
Keyword(s):  
Total Knee Replacement ◽  
Peripheral Nerve ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Knee Replacement ◽  
Analgesic Effect ◽  
Peripheral Nerve Block ◽  
Number Of Patients ◽  
Total Knee ◽  
Nerve Block Anesthesia

AbstractIntroduction: Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The main aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia.Methods: This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status.Results: The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P<0.01) and pain scores during 24h and 48h after the surgery were lower in the same group of patients (3.21±1.74 vs 5.02±2.23, P=0.037; 3.03±1.57 vs 5.67±2.51, P=0.028). Spinal anesthesia group had a larger number of patients with significant hypotension (3.84% vs 15.38%, P=0.01), as well as a larger number of patients who received vasopressors (0% vs 9.61%, P<0.01).Conclusion: Both anesthesia methods demonstrated sufficient analgesic efficacy in total knee replacement, although there was less pain severity and longer analgesic effect of peripheral nerve block anesthesia in patients who were 60 years old or older. Spinal anesthesia showed a significantly higher degree of hypotension than in those patients receivingperipheral nerve block anesthesia.

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