PSOAS COMPARTMENT AND PROXIMAL SCIATIC NERVE BLOCKS VERSUS LUMBAR SPINAL ANESTHESIA FOR LOWER EXTREMITY SURGERIES

Background: One of the types of peripheral nerve blocks [PNBs] is the combined lumbar plexus (psoas compartment) and proximal sciatic nerve blocks which are frequently used for patients needing lower extremity surgeries. Now its role has expanded from the operating suite into arena of post-operative and chronic pain management thus providing optimal anesthetic care. Objectives: This study aimed at evaluation of the analgesic effect of combined psoas compartment and proximal sciatic nerve blocks in lower extremity surgeries (intra- and postoperatively) and compare this with the analgesic outcome of lumbar spinal anesthesia. Methods: This study was conducted on sixty patients of both sexes, ages between 18 and 60 years, and ASA physical status I II selected from those admitted in the orthopedic department units of Ain Shams University hospitals, who were schedueled for surgical procedures on femur, knee joint, tibia, or ankle joint. Informed written consents were taken from all patients after approval of Ain Shams University medical ethics committee. The 60 patients were then randomly allocated into two groups. Group A {CPS}; thirty patients were subjected to psoas compartment block (posterior approach) by injecting a solution 30 ml of bupivacaine 0.25 % + 1 ml of adrenaline 1-200 000 combined with proximal sciatic nerve block (Labat s approach) by injecting 20 ml of the same mixture. Group B {SB}; thirty patients received a single injection lumbar spinal anesthesia at L3/L4 level by using 12.5 - 20 mg (2.5 - 4 ml) of hyperbaric bupivacaine 0.5 % + 25 μg fentanyl. Results:highly significant difference in pain score (VAS) measured at 160 minutes of inducing anesthesia and at 2, 4, 6, and 12 hours postoperatively, being much higher among SB patients (P 0.001). Time of first requirement of rescue analgesia (pethidine IM) was much delayed in CPS patients than in SB patients. Regarding the total dose of opioid analgesia given to the studied groups during the first 24 postoperative hours, it was much higher in SB group (P 0.001). Adverse reactions were noticed more apparently in SB group (spinal block) as 16. 7 % had experienced hypotension in the early stages after induction of anesthesia, while in group A patients only 3.3 % had the same problem. Conclusion: combination of psoas compartment block by and proximal sciatic nerve block provides adequate intraoperative analgesia for major lower extremity procedures and superior to lumbar spinal block in maintaining prolonged postoperative analgesia with significantly lower consumption of opioid analgesics, early ambulation, rapid hospital discharge and far less complications associated with neuroaxial blocks like; bilateral sympathetic blockade with consequent hemodymic instability, meningeal irritation and others.