Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Abstract

Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing "Lumbar Plexus Block and sciatic nerve block" with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre; a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20-40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p < 0.001). Finally, patient satisfaction was significantly higher in Group B. Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.