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172 Ultrasound guided combined sciatic plus femoral nerve block in high risk patients posted for lower limb surgeries
  1. N Adhyapak,
  2. R Mane,
  3. M Patil,
  4. R Kerur,
  5. P Apoorva and
  6. A Qadir Zeeshan
  1. KAHER’s J N Medical College, Belagavi, India


Background and Aims Regional Nerve Blocks are now the mainstay for high risk patients undergoing surgery where General, Spinal or Epidural Anaesthesia have poor outcome. Combined Sciatic and Femoral Nerve block given for lower limb surgeries like amputation, arthroplasty, ORIF in patients having multiple co-morbidities like Ishaemic Heart Disease (IHD), COPD, Uncontrolled DM and HTN. Ultrasound guided nerve blocks are effective, safe and have reduced incidence of neurological damage and Local Anaesthetic Systemic Toxicity (LAST).

Methods 5 patients undergoing lower limb surgery, in KLE’s Dr. Prabhakar Kore Charitable Hospital and MRC were considered. Three of the patients had IHD with EF 40%. One had RV Dysfunction with IVC collapsibility <50%. Another had COPD and was in sepsis. A complete pre-anaesthetic evaluation was done after selecting appropriate patients. Under ultrasound guidance, with patient in sciatic and femoral nerve blocks were given with equal mixtures of 0.5% Bupivacaine + 2% Lignocaine + 2 ml of Soda Bicarbonate. Intra-operatively hemodynamics was maintained. Case 1 required rescue Epidural Anaesthesia. For case 3 i.v paracetamol was given for additional analgesia. In rest of the cases no additional analgesia/anaesthesia was needed.

Conclusions Combined Sciatic and Femoral Nerve block is an effective and viable alternative to either General, Spinal or Epidural Anaesthesia as it provides better hemodynamic stability and good post operative analgesia in high risk patients without resulting in any adverse incidents.

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