A peripheral nerve stimulator guided popliteal sciatic nerve block combined with adductor canal block in lower leg surgery- A sole anesthetic technique

Abstract

In lower leg surgeries involving fractures of distal tibia, ankle surgeries, debridement and PVD surgeries choice of anesthesia is usually regional anesthesia. When these patients are associated with co-morbid cardio-respiratory problems then it will become challenge for anesthesiologist to maintain homeostasis with good surgical anesthesia. Ayukut urfalioglu suggested another alternative technique in the form of Adductor canal block plus Lateral approach popliteal sciatic block as good alternative for these surgeries with better Intra-operative Haemodynamic Stability, additional post-operative pain relief and less requirement of systemic analgesia post-operatively.In this prospective randomised controlled trial, we aim to explore the efficacy of Adductor canal block plus Popliteal Sciatic Block for Lower leg surgeries. Sixty patients (ASA I, II, III) undergoing lower limb surgeries were randomly allocated in 2 groups (30 patients in each group). In Group P patients received PNS guided Adductor canal block combined with popliteal sciatic block and in group S patients received unilateral spinal anesthesia.: The primary objectives were to evaluate duration of sensory and motor block and post-operative pain relief. Secondary objectives included intra operative requirements of additional anesthesia and intraoperative haemodynamic stability.There was significant intraoperative haemodynamic stability and post-operative pain relief attributable to Group P. Time for first requirement of rescue analgesia post-operatively was significantly higher in Group P compared to Group S (Group P Mean SD15.9±5.26 vs 6.05±1.23 in Group S with p= < 0.0001).Combined adductor canal block and popliteal sciatic block can be an alternative technique with advantage of prolonged post-operative analgesia and haemodynamic stability.

Comparison of a Peripheral Nerve Block versus Spinal Anesthesia in Foot or Ankle Surgery: A Systematic Review and Meta-Analysis with a Trial Sequential Analysis

“…Finally, nine studies satisfied the inclusion criteria and were incorporated into this study [7][8][9][10][11][12][13][14][15]. Two studies included below-knee amputation (BKA), and the authors of two studies provided additional data excluding BKA at our e-mail on request [10,15]. Thus, nine studies with a total of 802 patients were included in our meta-analysis (Figure 1).…”

“…Seven studies performed ultrasoundguided PNBs with or without a nerve stimulator [7][8][9][10][11]13,14]. Two studies used a nerve stimulator alone [12,15]. Seven studies performed two PNBs (femoral or saphenous and sciatic nerve blocks) [7,[9][10][11][12][13]15].…”

“…Two studies used a nerve stimulator alone [12,15]. Seven studies performed two PNBs (femoral or saphenous and sciatic nerve blocks) [7,[9][10][11][12][13]15]. Dabir et al performed three PNBs (femoral, lateral femoral cutaneous, and popliteal blocks), and Yang et al performed four PNBs (femoral, obturator, lateral femoral cutaneous, and sacral plexus blocks).…”

“…The risk of bias assessment performed using the Cochrane tool for the included studies is presented in Table 2. Studies were judged to have low risk [7,14], some concerns [8,9,[11][12][13], or high risk [10,15]. Among the nine included studies, bias in the measurement of the outcome and bias in the selection of the reported results were assessed as "low risk", except for Chauhan et al's study [15]; bias arising from the randomization process; bias due to deviations from intended intervention; and bias due to missing outcome data were assessed as "some concerns" in four studies, three studies, and two studies, respectively.…”

“…Therefore, these techniques are traditionally not used as a single anesthetic technique for foot and/or ankle surgery but are combined with general anesthesia or spinal anesthesia for postoperative pain relief [5,6]. However, some studies have recently demonstrated that PNBs alone or combined can provide adequate anesthesia in foot and ankle surgery [7][8][9][10][11][12][13][14][15].…”