Comparıson of postoperatıve paın ın arthroscopy planned patıents under spınal anesthesıa wıth combıned scıatıc and femoral block applıcatıon

In this study we aimed to compare the application of a combined ultrasound-guided anterior sciatic and femoral block with unilateral spinal anesthesia in outpatient knee arthroscopy patients, in terms of hemodynamic parameters, intraoperative anesthesia, postoperative analgesia, postoperative motor block and side effects.Randomly selected 60 patients who were ASA I-II, were divided into two groups. In Group 1 (n = 30) patients were applied unilateral spinal anesthesia with hyperbaric 0.5% bupivacaine 7.5 mg given in 40 seconds. Group 2 (n = 30) patients underwent an anterior approach of sciatic block combined with femoral block. Combined anterior sciatic-femoral nerve block was made by using ultrasound and 2 Hertz and 0.5 -1 mA current peripheral nerve stimulator by giving 10 ml of %1 prilokain ve 10 ml of bupivakain after seeing contractions of three different branches of femoral nerve by a teflon coated short needle. The sciatic nerve block was applied by using a modified anterior approach with ultrasound and nerve stimulation, giving 10 mL 1% prilocaine and 10 mL bupivacaine. Sistolic,diastolic,mean arterial pressure(SBP, DBP, MAP),heart rate (HR) and SPO2 baseline values, values measured 5, 15, 30, 45, 60 minutes after administration of drug and postoperative 6, 12, 24th hour values were recorded. The maximum level of sensory block, intraoperative quality of anesthesia, operative time, intraoperative and postoperative complications, duration of motor block regression, first postoperative urination and first postoperative analgesia need, postoperative pain VAS at rest and movement were assessed. Between the groups, no statistically significant difference was found in demographic data and the duration of the operation. Significant changes ofhemodynamic parameters in Group 1 according to the baseline values was observed as hemodynamics remained stable, according to the baseline values in Group 2. Motor block regression time (Bromage score) was higher in Group 1 compared to Group 2.In Group 1, none of the patients required additional sedation and analgesia. 3 of Group 2 patients required additional analgesia peroperatively and IV fentanyl was administered. In 3 of Group 1 patients urinary catheterization was performed for emptying the bladder after development of globe vesicale. In one of Group 1 patients, peroperatively block level rise with demonstration of profound bradycardia and hypotension, 0.5 mg atropine and 1 mg epinephrine was administered IV.Each of the two groups did not differ significantly in terms of the quality of anesthesia. Between the two groups at all time points in post-operative period, no significant differences were found for Visual Pain Scale. Statistically no difference between the groups was found for the time of first urination. Duration of first analgesia need was significantly shorter in sciatic-femoral group. As a result, the two techniques, while providing adequate anesthesia, alhough we use the minimum dose of bupivacaine in application of unilateral spinal anesthesia, patients? hemodynamics remained more stable in combined sciatic femoral block. For this reason, we would suggest that combined sciatic femoral block, especially in high-risk patients should be preferred. Especially in trauma patients, the anterior sciatic and femoral block might be preferred in terms of giving the patient a more comfortable position. We believe that the most appropriate anesthetic technique in outpatients should be evaluated by experts with all these things taken into consideration