Comparative Study between Unilateral Spinal Anesthesia Versus Ultrasound Combined Femoro-Sciatic Nerve Block for Lower Limb Surgery

Abstract
Background: The advantages of Unilateral Spinal An-esthesia (ULSA) over bilateral spinal anesthesia are less doses, cardiovascular side effects, and hospitalization. Femoral/Sciatic Nerve Block (FSNB) may decrease post-operative pain, nausea and vomiting, length of stay, surgical stress, morbidity and mortality and may improve mobilization and recovery of gastrointestinal function.
Aim of Study: The aim of this study is to compare ULSA versus FSNB by Ultrasound (US) guided as anesthetic tech-nique for cases undergoing elective lower limb surgery.
Material and Methods: This prospective randomized study was carried out on 60 adult educated patients, aged 18:60, of both sex, ASA I-II and scheduled for lower limb surgery at Tanta University Hospitals. Patients were randomized into 2 equal groups (30 patients in each); Group-I: ULSA and Group-II: US guided FSNB. Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded before block and every 15min intraoperative and at 30, 60min, 2, 3, 4, 6 and 12h post-operative. Onset and duration of both sensory and motor block, the first time for need of rescue analgesia (morphine) and Visual Analogue Scale (VAS) at rest and with activity (at 0, 1, 2, 3, 4, 6 and 12hr) were recorded. Patient and surgeon satisfaction and any post-operative side effect were recorded.
Results: Onset of sensory and motor block was signifi-cantly shorter in ULSA, but the duration of sensory and motor block was prolonged in FSNB with delayed first dose of analgesic. Intraoperative HR and MAP showed insignificant difference and post-operative significant increase in ULSA. VAS at activity showed earlier need for rescue analgesic in ULSA. There was no significant difference in surgeon and patient satisfaction with minimal side effects.
Conclusion: Both ULSA with 2ml heavy bupivacaine 0.5% given slowly over one minute and US guided FSNB using combination of 0.25% bupivacaine and 1% lidocaine resulted in comparable adequate intraoperative anesthesia, stable hemodynamics and adequate surgeon and patient satis-faction with minimal side effects. US guided FSNB was superior to ULSA in post-operative analgesia.