Comparison of Combined Sciatic(Winnie's) Femoral Nerve Block, and Subarachnoid Block Anesthesia for Lower Limb Surgery
Condition: Anesthesia Local
Study type: Interventional

Summary: 
      60 ASA grades- I, II or III patients, undergoing lower limb surgeries, will be randomly
      allocated in 2 groups of 30 patients each. In group S- subarachnoid block with 0.5%
      Bupivacaine (hyperbaric) 2.5ml will be given in lateral position and group B received femoral
      3 in 1 block in supine position(with landmark technique) with 20 ml of 0.25% of Bupivacaine,
      followed by Sciatic block in lateral position with 20 ml of 0.25% Bupivacaine. Onset and
      duration of sensory and motor block, time of first analgesic requirement, VAS Scores at end
      of block and surgery, hemodynamic effects, patients' and surgeon's satisfaction will be
      evaluated.
    

Detailed description: 
      After taking approval from institutional ethics committee, 60 ASA grade - I, II, III patients
      will be enrolled in the study undergoing lower limb surgeries. Patients will be randomly
      allocated in 2 groups of 30 patients each - Group S (spinal group) and Group B (nerve block
      group). Informed consent shall be taken prior to procedure. Patients will also be told about
      VAS score for pain- 0= no pain and 10= worst imaginable pain.

      In the operating room, after securing 18G IV cannula, all standard monitors will be attached
      (NIBP, SPO2, ECG, Temperature probe, foley's catheterization). Patients will be premedicated
      with inj. Ondansetron-4mg IV stat and inj. Midazolam- 1mg IV stat in both the groups before
      starting the procedure. Group S (SAB)- patients will be preloaded with 10mg/kg Ringer
      lactate. Subarachnoid block in L3-L4, L4-L5 space with 0.5% Bupivacaine (Hyperbaric)-2.5ml
      will be given in lateral position with involved limb in dependent position. Patient kept in
      same position for 15 minutes and then turned supine. Group B (peripheral nerve block)-
      femoral 3 in 1 block in supine position(with landmark technique) will be given with 20 ml of
      0.25% of Bupivacaine followed by sciatic block in Labat's approach in lateral position with
      20 ml of 0.25% Bupivacaine .

      Sensory block will be evaluated using the pinprick test using 22-gauge hypodermic needle, and
      it will be judged adequate if there will be a complete loss of pinprick sensation at T12 in
      the spinal group, or in the femoral and sciatic nerve distribution in the sciatic-femoral
      group. Onset of Motor blockade will be taken when Bromage score 4 would have been achieved.
      Bromage score 1- free movement of legs and feet; 2- just able to flex knees; 3- unable to
      flex knees but free movement of feet; 4- unable to move legs or feet. VAS score would be
      assessed after the procedure and surgery. Patients' vitals will be recorded before procedure,
      just after the procedure and intraoperative at 5, 15 and 30 min of surgery. After completion
      of surgery, hemodynamic parameters would be recorded and patient would be asked about VAS
      score. After surgery, patient's and surgeon's satisfaction would also be evaluated as 'Yes'
      or 'No'. Duration of analgesia will be calculated from onset of sensory blockade to 1st
      requirement of analgesic (VAS score >5). Injection Diclofenac- 75mg iv infusion will be given
      for treatment of pain.
    

Intervention name(s): Subarachnoid block; combined Femoral and Sciatic nerve block
Intervention type(s): Procedure; Procedure
Intervention description(s): Subarachnoid block will be given using 2.5 ml of 0.5%Bupivacaine for lower limb anesthesia; Femoral and Sciatic nerve blocks will be given using total 40 ml of 0.25%of Bupivacaine to anesthetise for lower limb surgery
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: regional anesthesia; lower limb surgery; Bupivacaine