Comparison of Ultrasound Guided Lateral and Posterior Approach of Popliteal Sciatic Nerve Block for below Knee Surgeries-A Randomized Comparative Study.
Abstract
Background: The Popliteal Sciatic Nerve Block(PSNB) provides Excellent anaesthesia and analgesia and can be blocked through anterior,posterior,lateral approaches.We compared PSNB through Lateral and posterior approaches under ultrasound guidance (USG).We carried out this study since there are only few studies comparing sciatic nerve visibility(SNV )score and lateral and posterior approach under USG .The Assessment included SNV score,ease of performance, block success rate, Total duration of analgesia.
Method:70 patients received PSNB either through posterior approach(Group A(n=35))in prone position or lateral approach(group B(n=35))in supine position using USG and nerve stimulator.Both groups received 0.5% Bupivacaine(20ml).After USG scanning of the PSN,image was saved to evaluate SNV.Time taken,number of attempts required to perform the block, onset of sensory and motor block and hemodynamic parameters were assessed for 24 hrs.Postoperatively VAS score,total duration of analgesia and time for first rescue analgesic requirement were recorded for 24 hours.
Results: SNV score was better in posterior approach(4.49 ± 0.61 ) than lateral approach(4.11± 0.72).Less Block performance time required in posterior(10.26 ± 4.10 min) than lateral approach(12.37 ± 4.20 min).Less number of attempts were required in posterior approach(1.20 ± 0.41) than the lateral approach(1.43 ± 0.50).In Group A,80% of patients required single attempt and 20% required 2nd attempt to perform the block. In Group B, 57.1% of patients required single attempt and 42.9% required 2nd attempt which is statistically significant.
Conclusion: The sciatic nerve visibility,performer’s ease score were better in posterior approach than lateral approach.Other parameters like block success rate,quality of blockade,total duration of analgesia,need for first rescue analgesia were similar in both the groups.
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