Ultrasound-Guided Femoro-Sciatic Nerve Block versus Hemispinal Anesthesia in Acute Lower Limb Ischemia: A Prospective Randomized Comparative Study

Mostafa Sayed Ahmed Mohammed Elawady, Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt.
Nehal Alaa EL-Dien Abbass Hamza, Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt.
Mohammed Ahmed Ahmed Sultan, Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt.
Hazem ELsayed Moawad, Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt.
Tarek Habeeb Ramadan, Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt.Follow

Subject Area

Anaesthesia and Surgical Intensive Care

Article Type

Original Study

Abstract

Background: Acute lower limb ischemia (ALLI) is a critical condition that requires prompt surgical intervention. The choice of anesthetic technique can have a significant impact on patient outcomes. The Purpose of this study was to compare the safety and efficacy of femoro-sciatic nerve block (FSNB) guided by ultrasound and hemispinal anesthesia (HSA) among patients undergoing surgery for acute lower limb ischemia.

Methods: We prospectively studied 44, ASA Ⅱ-Ⅲ patients whose surgeries were planned for management of acute lower limb ischemia. Eligible patients were randomly allocated into two groups to be given either HSA or ultrasound-guided FSNB. The duration of the sensory block was our main outcome. Meanwhile, the secondary outcomes included following: the time to onset of motor and sensory blocks, length of surgery, extent of motor block, intra-and post-operative hemodynamics, period to first request of analgesia, consumed analgesics and whole amount of analgesics, VAS score at both rest and activity as well as the incidence of any complications during or after the procedure.

Results: The FSNB group exhibited a significantly longer time to onset (min) and duration (hours) of both sensory and motor blocks compared to the HSA group (P≤ 0.001). Some intragroup significant reductions of HR and MBP were noticed in both HSA and FSNB groups in comparison to their basal values, starting respectively in HR (30 and 45 minutes) and MBP (1-2 mins and 15 min,) after initiating the blocks and continued till the postoperative period. MBP showed significant lower intraoperative values with the HSA than with the FSNB immediately after block (P= 0.009) and at the 15th min (P= 0.01). Postoperative VAS-rest at 2, 4, 6, and 12 hours (P= 0.02, 0.005, 0.03, and 0.037, respectively) and m-VAS at 2, 4, 6 hours (P= 0.018, 0.01, and 0.026, respectively) were lower with the FSNB than with the HSA. The FSNB group consumed significantly more fentanyl intraoperatively than the HSA groups (p= 0.001). The time till the first postoperative analgesic request was shorter significantly with the HSA group and more delayed with the FSNB group (P= 0.001).

Conclusions: In patients undergoing surgery for lower limb ischemia, ultrasound-guided FSNB was superior to HSA regarding anesthetic duration, hemodynamic stability, postoperative analgesia, and reduced analgesic consumption, with minimal complications.

Recommended Citation

Mohammed Elawady, Mostafa Sayed Ahmed; Abbass Hamza, Nehal Alaa EL-Dien; Ahmed Sultan, Mohammed Ahmed; Moawad, Hazem ELsayed; and Ramadan, Tarek Habeeb (2024) "Ultrasound-Guided Femoro-Sciatic Nerve Block versus Hemispinal Anesthesia in Acute Lower Limb Ischemia: A Prospective Randomized Comparative Study," Mansoura Medical Journal: Vol. 53 : Iss. 2 , Article 9.
Available at: https://doi.org/10.58775/2735-3990.1423