Comparative study of psoas compartment block and sciatic nerve block with that of spinal block anesthesia for lower extremity surgeries

Abstract

Aim and Objectives: Aim of the present study was to compare the efficacy of the block, hemodynamic effects, postoperative analgesia and side effects of combined psoas compartment sciatic nerve block with continuous spinal anaesthesia in adult patients undergoing lower extremity surgeries. Materials and Methods: Sixty patients of either sex, ASA grade I, II and III, age between 18-70 years, were randomly allocated into two groups. In group A, psoas compartment block was performed by posterior approach using 30cc of 0.25% bupivacaine and sciatic nerve block by classical posterior approach using the 20cc of 0.25% bupivacaine. In group B, continuous spinal anaesthesia was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 3cc (15 mg) of 0.5% heavy bupivacaine. We studied various parameters of block, hemodynamic effects, duration of postoperative analgesia and any complications. Results: Group B had earlier onset of sensory and motor block as compare to group A. The mean duration of sensory and motor block was significantly prolonged in group A than in group B. The efficacy of sensory blockade was comparable in both the groups while in group A 90% patients and in group B 97% of patients had complete motor blockade. The incidence of hypotension was more with group B as compared to group A. The duration of post-operative analgesia was longer in group A than in group B. No major complications were observed in both the groups. Conclusions: It was concluded that combined psoas compartment block and sciatic nerve block is a beneficial alternative to existing anaesthesia techniques for lower extremities surgeries. Keywords: Bupivacaine, Combined psoas compartment-sciatic nerve block, Continuous spinal anaesthesia, Lower extremity surgeries, Post-operative analgesia, Sensory and motor blockade.