The comparison of the spinal anesthesia and combined femoral and sciatic block in terms of hemodynamic and anesthetic-analgesic effects in orthopedic lower extremity surgery

Aim: In this study, it was aimed to compare the onset times of motor and sensory block, hemodynamic parameters before and after surgery, disappearance of motor block, and analgesic effects of spinal anesthesia and combined sciatic block in patients undergoing lower extremity surgery. Material and methods: ın this prospective randomized controlled study, 40 patients aged 18-65 years old who would undergo orthopedic lower extremity surgery (ASA I-III) were included in the study after approving local ethics committee and informed patient consent. Patients were divided into two groups randomly. Group 1(n=20) was the spinal anesthesia group and group 2 (n=20) was the combined sciatic bloc group. In the first group, spinal anesthesia were performed with 15 mg heavy bupivacaine and in second group combined femoral sciatic block was performed with bupivacaine 5% and lidocaine %% + Saline (30,15,15 mL) solutions. 40 ml solution for sciatic nerve block and 20 ml solution for femoral nerve block were administered. 0.003 mg/kg midazolam were applied to all patients routinely before the procedure. Before and duringthe procedure, and during the surgery, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spO2 were monitored and values of 5,15 and 60 minutes before operation and 1,3,6 and 12 hours after operation were recorded. Motor and sensory block levels of patients were evaluated with modified Bromage scale and pin-prick test. Visual analog scale rates (0-10) and the times of first analgesic application were recorded. Results: Demographic data of patients were similar between two groups (p>0.05). Onset time of motor block was significantly higher in femoral sciatic group (p<0.05). Statistically significant decrease in systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse rate were observed in spinal anesthesia group (p<0.05). The time of first analgesic need was longer and VAS pain scores were significantly lower in combined femoral sciatic block (p<0.05). Conclusion: Femoral sciatic nerve blocks have some advantages compared to spinal anesthesia and other central blocks,affecting hemodynamic parameters lowly, being safer in cardiac patients,providinglonger postoperative analgesia, ability to place catheter and providing the possibility of intermittent drug implementation and a lower probability of side effects due to local anesthesia. We believe that because of above mentioned reasons combined femoral sciatic block is more appropriate approach than spinal anesthesia in orthopedic lower extremity surgery when performed by experienced anesthetist.