In patients with high comorbidity popliteal sciatic nerve block in foot surgery complications of low dose spinal anesthesia and comparison in terms of efficacy: A randomised controlled trial

Aim: It is a fact that the presence of systemic diseases increases the risks in anaesthesia practice. Chronic systemic diseases, especially cardiovascular and respiratory diseases, endocrine, neurological, etc., increase the risk of anaesthesia. Neuraxial block techniques and peripheral nerve blocks, which have been increasing in popularity in recent years, constitute an alternative to general anaesthesia methods. In this study, we aimed to compare the anaesthetic and analgesic efficacy of spinal anaesthesia and popliteal sciatic nerve block as an alternative to general anaesthesia in terms of patient comfort, complications and the need for postoperative analgesia in patients with high comorbidities undergoing foot surgery. Material and method: This study was performed on a total of 65 ASA 3-4 patients undergoing foot surgery in the departments of orthopaedics and traumatology and plastic and reconstructive surgery after obtaining ethics committee approval and patient consent. The patients were divided into two groups as spinal anaesthesia and popliteal sciatic nerve block. 33 patients underwent low dose spinal anaesthesia in lateral decubitus position and 32 patients underwent popliteal sciatic nerve block in prone position. Intraoperative haemodynamic parameters, postoperative pain status, complications and satisfaction levels were recorded. The analyses performed using SPSS 27.0 software included statistical evaluation of the data obtained. Results: No significant difference was found between the groups in terms of demographic data. The duration of anaesthesia procedure was significantly (p<0.05) higher in the popliteal anaesthesia group than in the spinal anaesthesia group. Systolic blood pressure at 5th minute and 15th minute was significantly (p<0.05) higher in the popliteal anaesthesia group than in the spinal anaesthesia group. Intraoperative nausea vomiting rate was significantly (p<0.05) lower in the popliteal anaesthesia group than in the spinal anaesthesia group. The postop 3rd hour, 6th hour, 12th hour Numeric Rating Scale rate was significantly (p<0.05) lower in the popliteal anaesthesia group than in the spinal anaesthesia group. There was no significant (p>0.05) difference between the popliteal anaesthesia and spinal anaesthesia groups in the postop 24.hour NRS rate. There was no significant (p>0.05) difference in anaesthesia satisfaction between popliteal anaesthesia and spinal anaesthesia groups. The first postop analgesia time was significantly (p<0.05) higher in the popliteal anaesthesia group than in the spinal anaesthesia group. Conclusion: In our study, although intraoperative haemodynamics in patients undergoing foot surgery were more stable in the popliteal block procedure group, haemodynamics were also quite stable in the spinal anaesthesia group. Postoperative pain-free time was found to be longer in patients who underwent popliteal block procedure compared to patients who underwent spinal anaesthesia. In addition, complications were found to be higher in the spinal anaesthesia group. Key Words: Popliteal Sciatic Nerve Block, Spinal Anaesthesia, Foot Surgery, Analgesia, Complications.