The Efficacy of Two Different Approaches Combined Sciatic and Femoral Nerve Blocks on Thigh Torniquet Pain Tolerance during Arthroscopic Knee Surgeries
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- Category: Vol. 84, December 2016
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The Efficacy of Two Different Approaches Combined Sciatic and Femoral Nerve Blocks on Thigh Torniquet Pain Tolerance during Arthroscopic Knee Surgeries, SAAD EL-BASHA AHMED, NEVAN ABBAS MEKAWY, MOHAMMED BELETA, REHAM MAGDY, MOHAMMED DOULA and MOHAMED A. HASSAN
Abstract
Background: Tourniquet pain is a consequence of lower limb surgery that is not much talked about. It's a pain that occurs in the upper thigh because of the tourniquet the surgeon uses to both restrict blood loss and make the surgical field bloodless so he can carry out the procedure with greater accuracy and speed.
Objective: The aim of the present, prospective, random-ized, blinded study was to compare thigh tourniquet tolerance when a proximal (posterior subgluteal) or anterior sciatic nerve approach was performed in patients scheduled for elective arthroscopic knee surgery.
Methods: In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when posterior sub-gluteal approach versus anterior approach of the sciatic nerve was used for arthroscopic-knee surgery.
One-hundred-twenty patients in Cairo University Hospital (Orthopedic Department) for 2 years (2013-2015) were divided into two groups of (60). A posterior subgluteal (Group 1) or Anterior (Group 2) sciatic nerve block was performed with 25mL Bupivacaine 0.25%. In both groups, a femoral nerve block was achieved. Patient comfort during block performance, sensory block was assessed, then the success rate, and thigh tourniquet tolerance were recorded by another anesthetist who was not involved in the induction of the block to avoid bias. Performance of the block was significantly more comfortable in Group 1 than in Group 2 (p<0.01). Completeness of the block at t 30min. and success rate were comparable in both groups.
Result: Thigh tourniquet pain increased with time in both groups. No statistically significant difference was observed between groups. We conclude that despite a complete sensory blockade of the posterior femoral cutaneous nerve in 91% of the patients, posterior subgluteal approach of the sciatic nerve provides no better thigh tourniquet tolerance than the anterior approach. The posterior approach is as efficient as anterior but more comfortable for the patient and is the preferred technique for knee surgery.