551: Ultra-Sound Femoral Nerve Block Combined With Continuous Sciatic Nerve Block for Lower Limb Arterial Bypass Surgery

INTRODUCTION: Peripheral nerve blocks (PNB) can provide surgical anesthesia with better cardiorespiratory stability and is the best option for life-saving procedures where both general and central neuraxialanesthesia are risky, and no fasting, , or preoperative optimization is required. One of the most useful anesthetic technique is the combination of sciatic and femoral nerve block (3:1) for lower limb surgery. Peripheral nerve blocks are generally suitable for lower limb surgeries because of the peripheral location and the potential to block pain pathways at multiple levels. Also PNBs avoid hemodynamic instability and, facilitate postoperative pain management, and assure a timely discharge of the patient. MATERIAL AND METHODS: In this prospective observational study 50 patients of 22 to 67 years age group of both sexes were included who were posted for lower limb surgeries. Patients were randomly divided into two groups of 25 each. In Group A: 20 ml of 0.5% ropivacaine for femoral nerve block and 20 ml of 0.5% ropivacaine for sciatic nerve block was given to the patients. In group B: 20 ml of 0.5% ropivacaine plus 25 µg fentanyl for femoral nerve block and 20 ml of 0.5% ropivacaine plus fentanyl 25 µg for sciatic nerve block was given. Visual analog scale (VAS) with 0 – 10 cm line was used to see the level of anesthesia in the postoperative period and interpreted as “0” means “no pain” and mark “10” means “severe pain.” Pain score was assessed every 30 min during surgery. If pain is experienced during surgery injection ketamine 0.5 mg/kg intravenously. RESULTS: This study was carried out on 50 patients divided into two groups of 25 each of age group of 22 to 67 years posted for lower limb surgeries. In group A mean age of the patients was 43.78± 12.47and in group B it was 42.33± 13.29. Out of total 25 patients operated in group A 21 (84%) were male and 4 (16%) female, while in group B male and female were 22 (88%) and 3 (12%) respectively. Mean onset of sensory block (Minutes) in group A and Group B was 11.94 ± 3.54 and 12.19 ± 2.67 respectively. Mean onset of motor block in group A was 17.59 ±3.47 minutes and in group B was17.87± 2.78 minutes. Total duration of sensory block in group A was 13.96 ± 0.27 hours and in group B 13.05 ± 0.98 hours. Total duration of motor block in group A was11.58 ± 1.56 hours and in group B12.88 ± 0.96 hours. VAS score was 0 till 8 hours of the study period then it started increasing in both the groups. Patients demanded the first dose of rescue analgesia at 16th hour. CONCLUSION: Combined femoral-sciatic nerve block is one of the most useful anesthetic procedures and can be used without any major complications, it can also be used in critically ill patients.

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Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study

Orthopedic Reviews ◽

10.4081/or.2017.7063 ◽

2017 ◽

Vol 9 (2) ◽

Cited By ~ 2

Author(s):

Shoji Nishio ◽

Shigeo Fukunishi ◽

Tomokazu Fukui ◽

Yuki Fujihara ◽

Shohei Okahisa ◽

...

Keyword(s):

Postoperative Pain ◽

Sciatic Nerve ◽

Total Hip Arthroplasty ◽

Nerve Block ◽

Hip Arthroplasty ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Sciatic Nerve Block ◽

Nerve Blockade ◽

Continuous Femoral Nerve Block

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

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