Abstract
Background: Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches. Aims: To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate. Settings and Design: After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation. Methods: Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28). femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking for rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA. Result: Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach. Conclusion: Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate
Highlights
Patients who undergo below-knee amputation usually present with a poor general condition and multiple comorbidities as diabetes, hypertension and ischemia which make General Anaesthesia (GA) a risky option
Our study included 56 patients scheduled for below knee amputation surgery done under regional anaesthesia by sciatic nerve block either through sub gluteal or popliteal approaches together with femoral nerve block
Patients in the group P had a shorter time to perform the block and to achieve sensory and motor block, longer block duration and less overall complications when compared to patients in group G, while none of the patients in both groups showed signs or symptoms of Local Anesthetic Systemic Toxicity (LAST)
Summary
Patients who undergo below-knee amputation usually present with a poor general condition and multiple comorbidities as diabetes, hypertension and ischemia which make General Anaesthesia (GA) a risky option. Ultrasound guided regional nerve blocks have become popular and are frequently used for anaesthesia and postoperative pain control of such cases, having the advantages of providing a good intraoperative anaesthesia as well as a prolonged postoperative analgesia that may last for up to 20 hours [1, 2]. Due to its long course, it can be blocked at different levels using different approaches for anaesthesia as well as analgesia during lower limb surgery, out of these approaches the sub-gluteal and the popliteal approaches were successfully done by previous studies [1, 3]. Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, it can be performed at different levels via different approaches
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