Anesthesia & Clinical Research
Open Access

Abstract

Comparison in Ultrasound Guided Femoro-Sciatic Nerve Block for Post-Operative Analgesia between Plain Levobupivacaine and Combination of Levobupivacaine with Dexamethasone in below Knee Lower Limb Orthopedic Surgeries - A Prospective Randomized Controlled Study

Anshit Abhi Pathania and Shweta Mahajan

Objective: Since femoral sciatic block is not as famous as brachial plexus block for upper limb, and postoperative pain management in lower limb surgeries is limited to adjuvant in subarachnoid block or epidural analgesia. We intended to study the efficacy of ultrasound guided femorosciatic block in providing adequate post-operative analgesia, in patients undergoing below knee orthopedic surgeries. Also dexamethasone has been proved to be a useful adjuvant with local anesthetics in upper limb blocks; we considered to be studied in this block too.

Methods: After approval of the institutional ethics committee, 65 patients planned for elective below knee orthopedic surgeries were enrolled in the study. Patients were randomly allocated to receive ultrasound guided femorosciatic block using levobupivacaine 0.25% in conjunction with or without dexamethasone 8 mg. Group L received 20 ml of 0.25% levobupivacaine+1 ml NS in femoral nerve block and 20 ml of 0.25% levobupivacaine+1 ml NS in sciatic nerve block. The Group D received 20 ml of 0.25% levobupivacaine+4 mg (1 ml) dexamethasone in femoral nerve block and 0.25% levobupivacaine+4 mg (1 ml) dexamethasone in sciatic nerve block. In the postoperative period analgesia was given only on demand. The time of receiving first rescue analgesia was recorded along with the total number of rescue analgesics required in the 24 hours. The post-operative adductor muscle weakness and day of ambulation was also noted.

Results: The demographic profiles of all the patients were similar. Group D had longer duration of analgesia and also the number of rescue analgesics required in 24 hours was lesser in group D. No patient had any block related or drug related side effects.

Conclusion: Ultrasound guided femorosciatic block provides propitious post-operative analgesia in below knee orthopedic surgeries and can be used for providing post-operative analgesia in below knee orthopedic surgeries, without any side effects. Furthermore, adding dexamethasone to the block helps in prolonging the efficacy of the block by increasing the duration of analgesia provided and reducing the number of rescue analgesics required.