Abstract

ln past few decades, there has been an increased interest in performing lower extremity peripheral blocks as it offers certain advantages over other anesthetic techniques. In cases of difficult airway, where General anaesthesia may pose difficulties and in spine deformities where Spinal anesthesia may be difficult, peripheral nerve blocks can be used safely. Objective: To compare anterior combined approach as described by Chelly and Pierre Pandin with conventional two skin injection (Winnie's and Beck's) sites for lower limb anesthesia Methods: Intervention study was conducted on 90 patients >18 years with ASA grade I-III. They were randomly divided into three groups of 30 each. Group A received '3-in-1' block by Wnnie's approach and sciatic nerve block by Beck's approach with two different skin injection sites. Group B received Femoral nerve block and Sciatic nerve block by anterior combined approach through single skin injection site as directed by Chelly. Group C received '3-in-1' block and Sciatic nerve block by anterior combined approach through single skin injection site as directed by Pierre Pandin. Time required for onset of Sensory and Motor block and total duration of analgesia were observed. Results: All three groups were comparable for age and sex (p>0.05). Time required for onset of Sensory and Motor block in femoral, tibial and obturator nerve was comparable across three groups (p>0.05) and total duration of analgesia was also similar in three groups (p>0.05). Conclusion: We can conclude that, all three anterior approaches for the Sciatic nerve block for lower limb surgeries below knee, not requiring tourniquet for prolonged period, can be safely used in high risk patients where General anaesthesia and other modalities of regional anaesthesia can't be used and repositioning of the patient for posterior approach is difficult. Hence, conventional. two skin injection sites approach can be preferred for lower limb anaesthesia.

Description