RESEARCH ARTICLE


Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach



Rania Maher Hussien*, Dalia Ahmed Ibrahim, Islam Gamal Hamed Abdelnaby
Department of Anaesthesia and ICU, Ain Shams University, Cairo, Egypt


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Creative Commons License
© 2018 Hussien et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Anaesthesia and ICU, Ain Shams University, 4 Eladeeb Mohamed Elsbaee, Elnozha, Cairo, Egypt, Tel: 01000544520; E-mail: raniamhm@yahoo.com


Abstract

Background:

Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches.

Aims:

To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate.

Settings and Design:

After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation.

Methods:

Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28) femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking to rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA.

Result:

Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, and required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach.

Conclusion:

Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate

Keywords: Below knee amputation, Femoral nerve block, Popliteal nerve block, Sciatic nerve block, Sub-gluteal, Ultrasound guided.