Comparative study between combined spinal-epidural anesthesia versus femoral/sciatic nerve block under ultrasound and nerve stimulator guidance for both-bone leg fractures

Abstract

Background General anesthesia has a lot of complications, so alternative procedures like combined spinal-epidural anesthesia (CSEA) are better but with their adverse effects on cardiovascular and pulmonary functions. New era tend toward ultrasound (US) guidance and nerve stimulator for nerve block to ensure better effects without any complications. Aim The aim of this study was to compare CSEA versus femoral/sciatic nerve block (FSNB) by US guidance and nerve stimulator as anesthetic technique for patients with both-bone leg (BBL) fractures. Patients and methods Ninety adult patients, ASA I–II, scheduled for fracture BBL were included in the study. Patients were randomized into two equal groups. Group I CSEA received intrathecal 5 mg of hyperbaric bupivacaine 0.5+15% μg fentanyl, and then 7 ml of epidural (0.375% of plain bupivacaine+fentanyl 2 μg/ml) was injected as a loading dose. Finally, an additional epidural of 4 ml of 2% lidocaine was given if the desired sensory level was not reached till after 20 min or the operation lasted more than 80 min. Group II underwent FSNB by using US guidance and nerve stimulator. We first blocked the sciatic nerve by injection of 15 ml of 0.25% bupivacaine and 10 ml of 1% lidocaine. Then femoral nerve block was done by injection of 20 ml of bupivacaine 0.25% and 10 ml of 1% lidocaine. Results There was no significant difference between both groups in demographic data and failure rate. The onset of sensory and motor block was shorter in CSEA group, but the duration of sensory and motor block was prolonged in FSNB group. First dose of analgesia required was earlier in CSEA group. Heart rate and mean arterial blood pressure showed significant decrease in CSEA group at 5, 15, and 30 min intraoperatively. Visual analogue pain scale was higher and need for rescue analgesia was earlier in CSEA group. Conclusion FSNB by US guidance nerve stimulation technique provides better block characteristics, longer duration of analgesic, better intraoperative hemodynamics, and decreased the need for postoperative rescue analgesia in comparison with CSEA in patients with BBL fractures.