Popliteal Sciatic Nerve Block and Adductor Canal Block
Condition: Popliteal Sciatic Nerve Block; Adductor Canal Block
Study type: Interventional

Summary: 
      The goal of this observational study is to determine the effect of adding adductor canal
      block to popliteal sciatic nerve block on patient-surgeon satisfaction, intraoperative
      sedation need, tourniquet pain, return time of motor block, and postoperative pain in
      patients undergoing hallux valgus correction surgery. The main question it aims to answer
      are:

        -  Does peroperative pain decrease?

        -  Do patient-surgeon satisfaction increase? The patients were divided into two groups, the
           Popliteal Sciatic Block (PSB) group, and the Popliteal Sciatic Block + Adductor Canal
           Block (PSB + ACB) group.
    

Detailed description: 
      Patients were randomly assigned into 2 groups as popliteal sciatic nerve block (Group PSB),
      popliteal sciatic nerve + adductor canal block (Group PSB + ACB). In this study, 52 patients
      scheduled for hallux valgus correction operations, in the American Society of
      Anesthesiologists I-III groups, between the ages of 18-80, were enrolled. Study was planned
      as a prospective, randomized and controlled trial. All patients were perfomed PSB with 10 ml
      0.5% bupivacaine and 10 ml 2% prilocaine in the prone position, using ultrasonography and
      nerve stimulator. 10 ml of 0.5% bupivacaine and 10 ml of 2% prilocaine were administered to
      the patients in the ACB + PSB group in the supine position, in addition to PSB. Patients with
      coagulopathy, infection at the region site of regional blockade, allergy of local anesthetic
      drugs, peripheral neuropathy and neurogenic disorders affecting the lower extremities,
      peripheral artery disease, mental retardation and those who did not give consent to study
      were excluded. All patients were sedated with 1-2 mg midazolam and 50 µg fentanyl. After the
      blocks were performed , sensory -motor block onset time, surgery-tourniquet time, tourniquet
      pain, motor block time, pain onset time, first analgesic administration time (NPRS≥4) and
      analgesic administered were recorded. Anesthesiologists evaluating these data were blinded to
      group distribution .
    

Intervention name(s): Popliteal Sciatic Nerve Block; Adductor canal block
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients undergoing popliteal sciatic block, the side where the procedure would be performed in the prone position was sterilized after appropriate antisepsis. After visualizing the popliteal artery in the popliteal fossa with the probe it was advanced proximally in a horizontal and minimally lateral position to determine the point of separation of the tibial and peroneal nerves from the sciatic nerve. Subcutaneous local anesthesia was applied at this point after the skin, and the stimulator needle was advanced towards the sciatic nerve in an in-plane approach, passing through the skin and subcutaneous tissue, and then the nerve stimulator was opened up to 1 mA. After observing motor movement in the foot, the stimulator was reduced to 0.3-0.5 mA, and after observing motor movements for duration of 0.1 ms, 10 ml of 0.5% bupivacaine + 10 ml of 2% prilocaine were administered to the target tissue; Patients in the group undergoing popliteal sciatic block + adductor canal block, with the extremity to be blocked slightly externally rotated, the anterior part of the thigh was prepared with the necessary antiseptic procedures while the patient was in the supine position. Using an ultrasound probe, the femoral artery was visualized by advancing the ultrasound probe distally, and the saphenous nerve was identified just lateral to the femoral artery, beneath the sartorius muscle. At the junction of the sartorius muscle and vastus medialis, 10 ml of 0.5% bupivacaine + 10 ml of 2% prilocaine were applied to the periphery of the saphenous nerve. Subsequently, the patient was turned prone, and a popliteal sciatic block was performed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Popliteal sciatic block, adductor canal block