Effectiveness of Ultrasound-guided Dual Nerve Block in the Below-knee Amputation

Abstract

Abstract Introduction: Below knee amputation (BKA) is a common surgical procedure for diabetic foot ulcers and necrotizing lower limb fasciitis patients. But, it is a painful procedure and inadequate postoperative analgesia impedes rehabilitation and prolongs hospitalization. An ideal pain management regimen should provide superior analgesia while minimizing opioid consumption and improving rehabilitation.Methods: We retrospectively reviewed medical charts of 218 patients who underwent BKA for diabetic foot ulcer or necrotizing lower limb fasciitis at a single center between January 2017 and September 2020. Two groups were analyzed: patients who received dual nerve block (DNB) before surgery (Group I; n=104), and patients who did not (Group II; n=93). By the exclusion criteria, 21 patients were excluded. The femoral, and sciatic nerves were each blocked separately under ultrasound guidance. This procedure was performed immediately before the operation. Results: Group I patients' subjective pain scores were significantly lower than those of Group II at 6, 12, and 24 hours after BKA (P <0.05). Group I’s morphine milligram equivalent (MME) was significantly lower than those of Group II at 72 hours after BKA (P <0.05). Also, the rate of postoperative nausea and vomiting (PONV) and delirium was significantly lower in Group I patients than those in Group II patients.Conclusion: Ultrasound-guided lower extremity nerve block surgery is excellent for early post-operative pain control, could be used as an accurate, and effective pain control method, and can reduce side effects of opioid consumption after BKA.