A comparative study of spinal bupivacaine with fentanyl versus ultrasound-guided combined lumbar plexus and sciatic nerve block in lower limb orthopedic procedures: A prospective randomized controlled trial.

Lathika G; Dr. Rajaram M; Elakkiya.G; Panneerselvam  Periasamy

doi:10.51168/sjhrafrica.v6i6.1974

Authors

Lathika G Assistant Professor, Department of Anaesthesiology, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Dr. Rajaram M Senior Resident, Department of Anaesthesiology, Government Hospital, Ulundurpet, Kallakurichi, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Dr. Elakkiya.G Assistant Surgeon, Department of Anaesthesiology, Government Hospital, Kattumannarkoil, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Dr.Panneerselvam Periasamy Assistant Professor, Department of Physiology, Government Erode Medical College, Perundurai, Tamil Nadu, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1974

Keywords:

Spinal anesthesia, bupivacaine, fentanyl, lumbar plexus block, sciatic nerve block, regional anesthesia, orthopedic surgery

Abstract

Background
Spinal anesthesia with bupivacaine and fentanyl is widely used for its rapid onset, while ultrasound-guided lumbar plexus and sciatic nerve blocks are gaining popularity for prolonged postoperative analgesia with fewer systemic side effects. Aim: To compare the efficacy of spinal bupivacaine with fentanyl versus ultrasound-guided combined lumbar plexus and sciatic nerve blocks in lower limb orthopedic procedures.

Methods

This prospective randomized controlled trial was conducted on 50 patients aged 18–65 years undergoing elective lower limb orthopedic surgeries. Patients were randomized into two groups: Group A received spinal bupivacaine (12.5 mg) + fentanyl (25 mcg); Group B received ultrasound-guided lumbar plexus block with 30 ml of 0.25% bupivacaine and sciatic nerve block with 25 ml of 0.25% bupivacaine. Primary outcomes included onset and duration of sensory and motor blocks, and duration of analgesia. Secondary outcomes included hemodynamic changes and complications.

Results

Both groups were comparable in baseline demographics, with a mean age of 49 years and a similar distribution of sex and ASA physical status. The onset of sensory and motor block was significantly faster in Group A (5–8 min and 6–10 min) compared to Group B (10–20 min and 12–20 min; p<0.001). However, Group B had a significantly longer duration of sensory block (6–8 hrs), motor block (3–4 hrs), and analgesia (8–12 hrs) (p<0.001). Hypotension was more common in Group A (48%) than in Group B (32%). Two patients in Group B required conversion to general anesthesia due to technical difficulties.

Conclusion

Ultrasound-guided lumbar plexus and sciatic nerve blocks provide longer postoperative analgesia with fewer hemodynamic changes, making them preferable in high-risk or prolonged orthopedic surgeries.

Recommendations

For lower limb orthopedic surgeries, ultrasound-guided lumbar plexus and sciatic nerve blocks are recommended, particularly in patients at risk of hemodynamic instability or requiring prolonged analgesia.

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