A comparative study of spinal bupivacaine and fentanyl versus combined lumbar plexus and sciatic nerve block in lower limb orthopedic procedures

Abstract

Context: Spinal anesthesia is a time-tested method for orthopedic surgeries of the lower limb while peripheral nerve block is a comparatively newer method and still under controversy. Aims: The aim of this study was to compare efficacy of spinal bupivacaine and fentanyl with combined lumbar plexus and sciatic nerve block in lower limb orthopedic procedures. Settings and Design: A randomized single-blinded prospective study conducted at orthopedic operation theater and perioperative area. Subjects and Methods: Sixty patients were randomly allocated into two groups, Group A received spinal anesthesia with 12.5 mg bupivacaine and 25 μg fentanyl, Group B received lumbar plexus block with 30 ml (0.25%) bupivacaine and sciatic nerve block with 25 ml (0.25%) bupivacaine. In Group B, three patients were converted to general anesthesia due to failure of development of block. In postoperative period, visual analog scale (VAS) score was assessed, and pethidine was used as rescue analgesic. Statistical Analysis Used: IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY, USA). Results: Faster onset of sensory and motor block was found in Group A. In the intraoperative period, incidence of hypotension and bradycardia was found to be higher in Group A although statistically insignificant. In the postoperative period, the VAS score difference between the two groups was found to be significantly higher in Group B till 6 h postoperative. The total duration of analgesia was significantly higher in Group B (690.00 ± 108.344 min) than in Group A (264.67 ± 25.962 min). The total dose of analgesic required in first 24 h was significantly less in Group B (200.00 ± 57.17 mg) than in Group A (371.67 ± 28.416 mg). Conclusion: Combination of lumbar plexus and sciatic nerve block provided effective unilateral analgesia for a prolonged time into the postoperative period.