Effectiveness of Analgesia of Combined Femoral and Sciatic Blocks Versus Epidural Anesthesia for Lower Limb Amputations
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- Category: Vol. 84, June 2016
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Effectiveness of Analgesia of Combined Femoral and Sciatic Blocks Versus Epidural Anesthesia for Lower Limb Amputations, TAMER I. ROUK and TAMER M. KHEIR
Abstract
Background:
Peripheral neural blockade appears to provide
effective analgesia compared with central neuraxial techniques.
We compared both techniques as an anesthesia plan for
unilateral lower limb amputations.
Aim of Work:
Comparing of onset of sensory and motor
block sufficient to perform the surgical procedure. Assessment
of duration of post-operative analgesia using Visual Analogue
Score (VAS), incidence of intra operative and post-operative
complications, and risk of failure: Complete failure, patchy
or single block only.
Patients and Methods:
Eighty patients, undergoing uni-
lateral lower limb amputations were prospectively randomized
to receive either combined femoral and sciatic nerve blocks
(single shot each) or lumbar epidural anesthesia. Combined
femoral sciatic block group (n=40) received isobaric bupiv-
acaine 0.375% (femoral 20ml and sciatic 20ml) with nerve
stimulator guidance. While epidural group (n=40) received
isobaric bupivacaine 0.375% using loss of resistance to air
technique for space detection then 5-mL aliquots were given
to attain a sensory level at T10 which is adequate for lower
li
mb amputation surgery. Block onset time, visual analogue
pain scores and first time to ask for analgesia were recorded
postoperatively and perioperative complications were also
assessed.
Results:
The onset of epidural block was significantly
shorter. However, statistically and clinically significant more
prolonged post-operative analgesia was noted with femoral-
sciatic block group. There was no major difference in peri-
operative complication within first 24h, apart from shivering
with epidural group and non-significant higher failure rate
with femoral-sciatic block group.
Conclusion:
The use of combined femoral-sciatic nerve
block is superior in prolonged post-operative analgesia to
conventional epidural analgesia in patients undergoing unilat-
eral lower limb amputations. However, block onset is faster
and success rate is better in epidural block.