Buprenorphine vs Clonidine as adjuvant for ultrasound guided popliteal sciatic nerve block in lower limb surgeries,A double blinded randomised study

INTRODUCTION

• The aim of the study was to compare the effectiveness of ultrasound-guided popliteal nerve block with two different additives with 2% xylocaine adrenaline in below knee surgeries,The popliteal nerve block is a block of the sciatic nerve in the popliteal fossa with the patient in the prone position,The block is ideal for surgeries of the lower leg, particularly the foot and ankle.

• By using ultrasound,the local anesthetic must be deposited proximal to the splitting of the sciatic nerve. By placing the probe at the popliteal crease and scanning the leg in the cephalad direction,both the tibial and peroneal components of the sciatic nerve can be visualized separately as they coalesce to form the sciatic nerve

OBJECTIVES

Primary objective:

• To determine the duration of effect of us guided popliteal sciatic nerve block with dose of 15 ml 2% lignocaine adrenaline with additive buprenorphine 0.5 ml with 5 ml normal saline and 15 ml of 2%lignocaine adrenaline with clonidine 0.5 ml and 5 ml normal saline to find out the onset and duration of anaesthesia

Secondary objective:

• To determine the requirement of tramadol as rescue analgesia in the first 24 hours

Study design

This study was designed as a Double blinded,Randomised control study

SAMPLE SIZE

Total sample size=68

Group A=34

Group B =34

INCLUSION CRITERIA

• Patient coming for below knee surgeries with ASA grade1, grade 2, grade 3

EXCLUSION CRITERIA

• Patient refusal
• Known allergy to local anesthetics
• Bleeding diathesis
• Use of any anti-coagulants
• Inability to provide informed consent
• Severe kidney or liver disease
• Patient with psychiatric disorders

METHODOLOGY

• All patients will be premedicated with alprazolam 0.5 mg orally.Heart rate, noninvasive blood pressure, and peripheral O2 saturation will be continuously monitored during surgery and in the postoperative period
• Place the patient in the lateral position with the operative leg supported below the knee.
• Using high frequency ultrasound,a 23-G quincke needle will be introduced at least 7-cm superior to the popliteal crease
• With the probe parallel to the popliteal crease and at a level proximal to the nerve split, insert the needle at the lateral aspect of the probe and advance it toward the nerve. After the sciatic sheath is penetrated and the nerve is stimulated, inject 15mL of 2% xylocaine with adrenaline and buprenorphine 0.5ml in Group A and inject 15mL of 2% xylocaine with adrenaline and Clonidine 0.5ml

REFERENCES

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2. Rahimzadeh P, Faiz SH, Imani F, Jahromi MR. Comparison between ultrasound guided transversalis fascia plane and transversus abdominis plane block on postoperative pain in patients undergoing elective cesarean section: a randomized clinical trial. Iran Red Crescent Med J. 2018 Sep 1;20(9):7.

3. Kadam RV, Field J. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. Journal of anaesthesiology, clinical pharmacology. 2011 Jul;27(3):333.