Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach

Abstract

Background: Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches. Aims: To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate. Settings and Design: After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation. Methods: Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28). femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking for rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA. Result: Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach. Conclusion: Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate