Authors: Mohamed H. Khafaga, Nagwa M. El-Kobbia, Hossam El-Din F. Reda, Ehsan M.H Abdelrahman, Moustafa Abdelaziz, Ahmed Osmane Qorany.
Background: Anaesthesia for peripheral revascularization surgery is really challenging and the choice of the anaesthetic technique can contribute to the postoperative outcome.
Aims: To evaluate the effect of adding peripheral nerve blocks (Femoral and Sciatic) to general anaesthesia, as an analgesic technique, on the control of postoperative pain, reduction of surgical stress response, providing haemodynamic stability and reducing the vasospasm in the venous graft following femoropopliteal bypass surgeries
Methods: Patients were randomly categorized into two equal groups (20 each) by closed envelope method. In the general anaesthesia group, patients were induced with fentanyl, propofol and cisatracurium. An LMA was inserted and anaesthesia was maintained with isoflurane (1-2%) and fentanyl infusion with a controlled ventilation. In this group, analgesia was achieved postoperatively with nalbuphine and Ketorolac. While in the regional anaesthesia group, 20 patients received ultrasound guided femoral nerve block and sciatic nerve block 20 minutes prior to induction of general anaesthesia. General anesthesia was induced and maintained with the same technique as in group 1 without the fentanyl infusion. The parameters evaluated were the postoperative heart rate, mean arterial blood pressure, visual analogue scale at rest and movement, plasma nitric oxide and interleukin levels, total opoid consumption, patient’s satisfaction with the pain control and blood flow through the graft. Also complications such as nausea and vomiting were evaluated.
Results: It was found that combining ultrasound guided peripheral sciatic and femoral nerves blocks to the general anaesthesia provided a better postoperative pain control as demonstrated by a reduction in the heart rate, mean arterial blood pressure, visual analogue scale, total opioid consumption and pain mediators levels. It also helped the distal blood flow to the operated limb by reducing the vasospasm of the graft. Patient satisfaction did not show a statistical significance between the two groups.
Conclusion: It is better to combine ultrasound guided sciatic and femoral nerve blocks to general anaesthesia for peripheral revascularization surgeries.
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