USG guided popliteal sciatic and adductor canal block for below knee surgeries and postoperative analgesia in high risk patients

Abstract

The aim of the present study is to determine the USG guided popliteal sciatic and adductor canal block for below knee surgeries and postoperative analgesia in high risk patients. Methods: A prospective study was conducted at Bone & Joint hospital an associated hospital of GMC Srinagar, department of Anaesthesiology and critical care medicine, from September 2018 to August 2019. 50 patients with ASA physical status III-IV (diabetes, hypertension, hepatorenal disease, ischemic heart disease), aged 30-70 years were included in this study. Patients allergic to local anaesthetics, on opioids and other analgesics for chronic pain, a refusal for peripheral nerve block and with neurological deficits were excluded from the study. Routine investigations, coagulation profile, renal and hepatic function tests were obtained and 'nil per oral' order was placed six hours prior to the surgery. Analyse the block success rate and sensory and motor block onset time, hemodynamic parameters, duration of post operative analgesia and patient's overall satisfaction. Results: A total of 50 patients with significant co morbidities scheduled for below-knee surgery were included in this study. All patients obtained an adequate sensory and motor blockade and the surgery was performed successfully under ultrasound-guided popliteal sciatic and adductor canal block, with no additional analgesic requirement. The mean duration for sensory and motor block onset time was 3.45±0.52 and 4.77±0.47 minutes respectively. Hemodynamic parameters were maintained stable without gross fluctuation from baseline value throughout the procedure. Average duration of postoperative analgesia as assessed by NRS was ± 0.9 hours. Patient satisfaction as assessed by three-point Lickert's scale was satisfactory, with 80% of patients were graded as per Lickert's scale 1 and 20% of patients were graded as per Lickert's scale 2. Conclusion: Ultrasound-guided combined popliteal sciatic and adductor canal block is an effective alternative anaesthetic technique for below-knee surgeries with better stability of hemodynamic parameters and pain management in high-risk patients.