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.