A Comparison of Spinal Anesthesia Versus Lateral Approach of Popliteal Nerve Block for Diabetic Foot Surgeries

Background: Providing anesthesia for diabetic patients is a frequent challenge because of serious comorbidities. Spinal anesthesia may impair hemodynamic stability; periph-eral nerve blocks targeting the sciatic nerve may be a useful alternative. Objective: To compare Unilateral Spinal Anesthesia versus Popliteal Block in diabetic patients undergoing elective foot surgery to determine the method of better outcome. Patients and Methods: This randomized comparative study was carried out on sixty cooperative diabetic patients of both sexes who were scheduled for elective foot surgeries. According to the used method of regional anesthesia, patients were divided into: (F) group unilateral intrathecal block with low-dose (5mg) of hyperbaric bupivacaine plus intrathecal fentanyl (25pg), (M) group unilateral intrathecal block group with low-dose (5mg) of hyperbaric bupivacaine plus intrathecal midazolam (2.5mg), and (P) group in which the sciatic nerve at the popliteal fossa was blocked via lateral approach by injecting 30ml 0.5% bupivacaine (150mg) under ultrasound guidance and peripheral nerve stimulation assistance. The difficulty of the block performance, level of patient discomfort, block performance time, onset of sensory and motor blocks, postoperative pain intensity, time in hours to the first request for supplemental systemic analgesia postoperatively, its total consumption for 24 hours postoperatively and associated side effects were recorded in each group. Results: Statistically, it was found no significant differences between the demographic characteristics as well as the duration of surgery among the three groups. The groups did not differ significantly in the difficulty of the block perfor-mance. However, a longer duration for performing the block was observed in the P group. The level of patient discomfort was significantly lesser in the P group. The onsets of complete sensory and motor blocks were highly significant longer in the P group. Hemodynamic profiles of our patients were found to be remarkably stable throughout the intraoperative period. In the P group, postoperative VAS values were significant lesser and the time to first pain medication was significant longer. Moreover, the total dosage of analgesics during the first 24 hours postoperatively in group P was highly significant lesser compared to the other groups. Conclusion: The lateral approach for popliteal nerve block is an ideal alternative where it is preferable to avoid spinal anesthesia for foot surgeries in diabetic patients.