A COMPARATIVE STUDY OF CLINICAL EFFECTS OF SPINAL BUPIVACAINE VERSUS SCIATIC-FEMORAL NERVE BLOCK (ANTERIOR APPROACH) IN HIGH RISK GERIATRIC PATIENT FOR LOWER LIMB ORTHOPAEDIC PROCEDURES.

Corresponding Author:
Dr. Soumi Maiti,
#64, Rajkumar Mukherjee Road,
Alambazar, Baranagar, Kolkata-700035.
E-mail: rgkmch2009@gmail.com

ABSTRACT

BACKGROUND

Spinal anaesthesia is widely used for lower limb orthopaedic procedure in all age groups. The procedure is safe, but may lead to cardiovascular instability in high risk geriatric patient. Recently, sciatic-femoral nerve block is being used with satisfactory result.

The aim of the study was to compare the onset and duration of sensory and motor blockade, intensity and duration of post-operative analgesia, intraoperative and postoperative haemodynamics in between two groups, one receiving spinal anaesthesia and the other sciatic-femoral block (Anterior approach) in high risk geriatric age group.

MATERIALS AND METHODS

A randomised single-blinded clinical study was done on 60 ASA II and III geriatric patients undergoing lower limb orthopaedic procedure. In Group A (n = 30) patients received spinal anaesthesia with 2.5 mL 0.5% hyperbaric bupivacaine and Group B (n = 30) patients received sciatic-femoral block (Anterior approach) with 30 mL and 20 mL 0.25% bupivacaine respectively with nerve locator. Onset and duration of sensory and motor block, duration of analgesia, intensity of analgesia by Visual Analogue Scale (VAS) and haemodynamics (Blood pressure, Heart rate) were recorded. Side effects if any were noted.

RESULT

Our study revealed later onset of both sensory and motor block, but prolonged duration of analgesia in sciatic-femoral block compared to spinal anaesthesia. The result was statistically significant. Sciatic-femoral nerve block group had stable haemodynamics compared to spinal anaesthesia group (p < 0.05).

CONCLUSION

To conclude combined sciatic-femoral nerve block (Anterior approach) is a better alternative to spinal anaesthesia in high risk geriatric patients for lower limb orthopaedic procedure.

KEYWORDS

Spinal Anaesthesia, Sciatic-Femoral Block (Anterior Approach), Lower Limb Orthopaedic Surgery, High Risk Geriatric Patients.