الفهرس 
Pain PathwayOnly 14 pages are availabe for public view
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Abstract
Regional anesthesia can reduce the hazards and discomforts of general anesthesia including sore throat, airway trauma and muscle pain, and it also offers a number of advantages to outpatients undergoing surgery. These techniques provide analgesia without sedation, earlier discharge, and prolonged post-operative analgesia. Regional anesthesia reduces the requirements of opioids therefore reducing the incidence of post-operative nausea and vomiting.
The lumbar plexus (psoas compartment) block in combination with proximal sciatic nerve block are frequently used for patients undergoing lower extremity surgeries that include procedures on the hip, thigh, knee, leg, ankle and foot. Now the role of these techniques has expanded from the operating suite into arena of post-operative and chronic pain management.
This study aimed at evaluation of the analgesic effect of combined psoas compartment and proximal sciatic nerve blocks in lower extremity surgeries (intra- and post-operatively) and comparing this with the analgesic outcome of lumbar spinal anesthesia.
The study was conducted on 60 randomly chosen patients in Ain Shams University department of orthopedics after approval of the medical ethical committee. They were allocated in two groups of 30 patients each:
Group A: 30 patients were subjected to combined lumbar plexus block (posterior approach) and proximal sciatic nerve block (Labat’s approach) by injection of a 30 ml solution of bupivacaine 0.25% + 1 ml adrenaline 1:200,000 for the former and 20 ml of the same mixture for sciatic block. Three patients had partial block and thus were excluded from the results of the study.
Group B: 30 patients received a single injection lumbar spinal block at L3/L4 level by intrathecal injection of 12.5 - 20 mg (2.5 - 4 ml) of hyperbaric bupivacaine 0.5 % + 25 g fentanyl.
Both groups were adequately monitored and assessed intra- and post-operatively and they were meticulously compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first opioid dose consumed and total requirement in the 1st 24 postoperative hours. Also, modified Bromage scale was comparable between the two groups for monitoring the return of motor power. Plasma cortisol level was assessed in both groups at three different occasions without considering the normal intrinsic circadian rhythm. Hemodynamics, SpO2, demographic data and sedation score were also assessed.
Finally, results of the study revealed that combined psoas compartment and sciatic nerve block are superior to spinal anesthetic technique in major lower extremity surgeries regarding; postoperative prolonged analgesia, early ambulation, less hospital stay, less risk of hemodynamic complications or neurological injury, less requirement for opioid analgesia or NSAIDs and so avoiding their adverse effects.