COMBINED PSOAS COMPARTMENT BLOCK AND SCIATIC NERVE BLOCK VERSUS UNILATERAL SUBARACHNOID BLOCK AS A SOLE ANAESTHETIC TECHNIQUE FOR LOWER LIMB ORTHOPAEDIC SURGERY

COMBINED PSOASCOMPARTMENT BLOCK AND SCIATIC NERVE BLOCK VERSUS UNILATERAL SUBARACHNOID BLOCKAS A SOLE ANAESTHETIC TECHNIQUE FOR LOWER LIMB ORTHOPAEDIC SURGERY – A PROSPECTIVERANDOMISED CONTROLLED STUDY

PURPOSE - Our purpose of the study is to compare the quality of anaesthesiaand hemodynamic changes of combined psoas compartment block and sciatic nerveblock as a sole anaesthetic technique with that of unilateral subarachnoidblock for patients undergoing lower limb orthopaedic surgeries.

AIM-The aims of the study are :To compare combined psoas compartment and sciaticnerve block with subarachnoid block in terms of following parameters

1.Sensory block :

·        Onsettime

·        Peakeffect

·        Durationof sensory block

2. Motorblock :

·        Onsettime

·        Peakeffect

·        Durationof motor block

3.Vitalparameters:

4. Peri-operativecomplication

5. Durationof analgesia

6. Number ofrescue analgesic required within 24 hrs

Group(P):     (n=48)

In this group patients will begiven combined psoas compartment block and sciatic nerve block.

Group(S):    (n=48)

In this group patients will be given unilateral subarachnoidblock.

Psoas compartment block :

·        The block will be given in lateralposition. Surgical side leg will be in the nondependent position.

·        Two points will be marked – posteriorsuperior iliac spine (PSIS) and Intercristal line.

·        Linewill be drawn from the PSIS parallel to the spine and another line isintercristal line.

·        Pointof intersection of the two lines is the point of needle insertion.

·        Underall aseptic precaution 100mm 22 gauze insulated needle connected to nervelocator set at 3mA frequency will be inserted at this point. When the needleenters in the psoas compartment quadriceps motor response will be seen. Adequateproximity to the nerves will be assured by continued twitching after reducingthe stimulation to 0.5mA. After negative aspiration 25ml local anaestheticsolution will be injected.

Sciaticnerve block:

·        The sciatic nerve block will beperformed by classical Labat’s approach. The patient with same lateraldecubitus position (Sim’s position)

·        Two lines will be drawn: the firstfrom the greater trochanter to the sacral hiatus and second from greatertrochanter to the posterosuperior iliac spine (PSIS). A perpendicular will bedrawn from the midpoint of the greater trochanter‑PSIS line, caudad thatintersected the greater trochanter‑sacral hiatus line, which represent theinsertion point.

·        Under all aseptic measures theinsulated needle will be connected to nerve stimulator set at 3 mA, and will beinserted at right angles to the skin to elicit a motor response like planterflexion. Adequateproximity to the nerves will be assured by continue twitching after reducingthe stimulation to 0.5mA.

·        Afternegative aspiration 25ml local anaesthetic solution will be injected.

 

1 min

2 min

3  min

5  min

10 min

15 min

20 min

25

min

30 min

|sensory

Onset

          | Peak effect

          |motor

Onset

          | Peak effect

v  Post-operativeMonitoring of Patient:

Effect of Sensory block andpost-operative analgesia (Visual Analogue Score – VAS) will be assessed every1hr for first 6 hours, every 2 hour for next 6 hours and then at 18 and 24hours.

1hr

2hr

3hr

4hr

5hr

6hr

8hr

10hr

12hr

18 hr

24 hr

|Sensory block

|Motor block

|Analgesia