الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Regional anaesthesia has long been known to be beneficial to patients undergoing orthopedic surgery. Spinal or epidural anaesthesia are unnecessary and even undesirable for unilateral operations. A combination of femoral and sciatic nerve blocks is a useful alternative for single lower extremity surgery. This form of anaesthesia avoids sympathectomy and all other possible complications associated with neuraxial blocks. Although the anterior approach took longer time than the two other approaches to access and block the sciatic nerve alone, the total completion time for all blocks together was significantly less when using the anterior approach . This time advantage, coupled with the avoidance of discomfort and pain associated with intra-procedural repositioning of the patient conferred an overall benefit of using the anterior approach versus the more conventional transgluteal and subgluteal approaches. (104)
The purpose of this study is USG comparison of different approaches of sciatic nerve block, anterior approach, transgluteal approach, and subgluteal approach plus femoral nerve block for below knee amputation in diabetic foot patients as regards the duration of the procedure, feasibility of the technique, onset of sensory and motor blockade, result of the block, complications of the procedure and hemodynamic stability.
This study was carried out on 81 adult patients of sex, ASA II and III physical status. Patients were scheduled for below knee amputation on one of the lower limbs in diabetic patients under femoral nerve block plus one approach of sciatic nerve block.
Patients who completed the study were randomly assigned into three equal groups, twenty five patients each group. Patients received femoral nerve block and one different approach of sciatic nerve block, group I: anterior approach, group II: transgluteal approach, group III: subgluteal approach using a total volume of 25 mL of local anaesthetic bupivacaine 0.5% 10 mL for femoral nerve block and 15 ml for each approach of sciatic nerve block.
All patients were premedicated with 1-2 mg midazolam.
Sonosite ultrasound was used to identify the nerves and allow LA injection.
The following data were recorded for all patients in each group:
• Demographic data.
• Time required to perform sciatic block.
• Time required to perform the overall blocks.
• Onset of both sensory and motor blocks.
• The degree of pain during surgery
• Hemodynamic parameters including:
Heart rate (beats/min), MABP (mm Hg) and SPO2 (%) were recorded at the following times: baseline value, immediately after the block, with skin incision and every 15 mins during operation.
• Patients first time to call for postoperative analgesia.
• Duration of the motor block.
• Complications.
There was no significant difference between the three groups as regards demographic data.
As regards the time required to perform the sciatic block, there was a significant difference between the anterior group and the two other groups .The anterior approach took longer time than the two other approaches to access and block the sciatic nerve. As regards the total completion time for all blocks together there was significant difference between the anterior group and the two other groups. The anterior approach took shorter time than the two other approaches for the total completion time for all blocks together. This time advantage, coupled with the avoidance of discomfort and pain associated with intra-procedural repositioning of the patient conferred an overall benefit of using the anterior approach versus the more conventional transgluteal and subgluteal approaches.
There was no significant difference between the three groups according to the onset of sensory and motor blocks.
There was no significant difference as regards to pain perception intraoperative in comparison between the three groups.
As regards the hemodynamic data, there was no significant difference in HR, MABP and SPO2 at all the times of measurements. In comparison between the three groups as regards the mean difference (MD) in HR, MABP and SPO2 there was no significant difference between the three groups.
As regards the first time to call for postoperative analgesia, there was no significant difference in comparison between the three groups.
As regards the duration of motor block, there was no significant difference in comparison between the three groups.
As regards the complications, none of the patients had any complications either intraoperative or postoperative in the three groups.
The failure rate was 6 cases 7.4 % in which the sciatic nerve couldn’t be visualized clearly, 3 cases in the anterior group, 2 cases in the transgluteal group and 1 case in the subgluteal group. There was no significant difference in failure rate between the three groups.