Comparison of Ultrasound Guided Femoropopliteal Block versus Spinal Anaesthesia for Ankle Surgery

Afzal Shabbir; Khalid  Buland; Junaid  Zafar; Muhammad Asif  Hayat; Nasar ul Islam  Zakria; Syed Aqib Ali  Shah

doi:10.51253/pafmj.v75i5.11751

Authors

Afzal Shabbir Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Khalid Buland Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Junaid Zafar Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Asif Hayat Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Nasar ul Islam Zakria Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Syed Aqib Ali Shah Department of Anaesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i5.11751

Keywords:

Anaesthesia, Ankle, Block, Femoropopliteal, Spinal, Surgery

Abstract

Objective: To compare the sensory, motor, block duration and added analgesia requirements between ultrasound guided Femoropopliteal block and Spinal Anaesthesia in patients with malleolar fractures of the ankle.

Study Design: Randomized controlled trial (IRCT: 74290).

Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2023 to Feb 2024.

Methodology: One hundred ninety patients were analyzed randomized into the Spinal Anesthesia Group (Group S) (n=95) and the Femoropopliteal Block Group (Group F) (n=95). Primary variables measured were mean time to first rescue analgesia, patient satisfaction for pain relief 24 hours after surgery and 24- hour total dose of analgesia needed. Secondary variables observed were nausea/vomiting, hypotension, and headache 24-hours post-operatively.

Results: In the primary variables studied, mean time to require rescue analgesia as first dose was 3.780.54 hours in Group S versus 7.140.60 hours in Group F (p<0.001). Mean total dose of analgesia required in 24 hours post-operatively was 12.561.06 mg in Group S versus 6.290.63 mg in Group F (p<0.001).

Conclusion: Spinal Anesthesia provides early sensory and motor onset but Femoropopliteal block is superior when comparing block duration and total dose of analgesia needed in 24 hours post-operatively.

Downloads

Download data is not yet available.

References

1. Edgley C, Hogg M, De Silva A, Braat S, Bucknill A, Leslie K. Severe acute pain and persistent post-surgical pain in orthopaedic trauma patients: a cohort study. Br J Anaesth 2019; 123(3): 350-359. https://doi.org/10.1016/j.bja.2019.05.030

2. Li Y, Chen Y, Liu X, Chen J, Gan T, Zhang H. Patient pain and function after correction of posterior malleolar malunion. Foot Ankle Int 2021; 42(12): 1536-1546.

https://doi.org/10.1177/10711007211017831

3. Aiyer AA, Zachwieja EC, Lawrie CM, Kaplan JR. Management of isolated lateral malleolus fractures. J Am Acad Orthopaed Surg 2019; 27(2): 50-59.

https://doi.org/10.5435/JAAOS-D-17-00417

4. Garg B, Ahuja K, Sharan AD. Regional anesthesia for spine surgery. J Am Acad Orthopaed Surg 2022; 30(17): 809-819.

https://doi.org/10.5435/JAAOS-D-22-00101

5. Craig D, Carli F. Bromage motor blockade score–a score that has lasted more than a lifetime. Canadian Journal of Anesthesia/ Journal canadien d'anesthésie 2018; 65: 837-838.

https://doi.org/10.1007/s12630-018-1101-7

6. Russell I. A comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section. Int J Obstet Anesth 2004; 13(3): 146-152.

https://doi.org/10.1016/j.ijoa.2003.12.007

7. Hadzic A. NYSORA Nerve Block Manual: NYSORA Inc.; 2022.

8. Begum MR, Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement. J Med Case Rep Rev 2019; 2(11): 2589-8647.

9. Garg B, Ahuja K, Khanna P, Sharan AD. Regional Anesthesia for Spine Surgery. Clin Spine Surg 2021; 34(5): 163-170.

https://doi.org/10.1097/BSD.0000000000001096

10. Yurek JW, Gianakos AL, Mulcahey MK. Ankle Anatomy and Biomechanics. Female Athlete 2022: 161-167.

https://doi.org/10.1016/B978-0-323-75985-4.00019-2

11. Sugathan R, Mathews RM, PG V. A Comparison of Femoropopliteal Block versus Spinal Anesthesia for Malleolar Surgeries. Int J Recent Surg Med Sci 2023: 10(Suppl 1); S39-S43.

https://doi.org/10.1055/s-0043-1761505

12. Delbos A, Philippe M, Clément C, Olivier R, Coppens S. Ultrasound-guided ankle block. History revisited. Best Pract Res Clin Anaesthesiol 2019; 33(1): 79-93.

https://doi.org/10.1016/j.bpa.2019.05.002

13. Hofmann-Kiefer KF, Gaube F, Groene P, Böcker W, Polzer H, Baumbach SF. “High ankle block” for surgery at the ankle joint. Foot Ankle Surg 2022; 28(8): 1254-1258.

https://doi.org/10.1016/j.fas.2022.05.006

14. Khan MJ, Babar A, Haq IU, Wadud R, Farid K, Waheed A. Comparison of Ultrasound-Guided Ankle Block Versus Anatomical Landmark-Guided Ankle Block in Ankle and Foot Surgery Under Regional Anesthesia. Pak J Med Health Sci 2022; 16(11): 652. https://doi.org/10.53350/pjmhs20221611652

15. Anjum MN, Mufti W, Shah YA, Ali I. Comparison of Ultrasound Guided Ankle Block versus Anatomical Landmark Guided Ankle Block in Minor Ankle and Foot Surgeries. Pak J Med Health Sci 2021: 15(11): 3484-3487.

https://doi.org/10.53350/pjmhs2115113484

16. Oguslu U, Gümüş B, Danışan G. Ultrasound-Guided Popliteal Sciatic Nerve Block: A Minimally Invasive Method for Pain Control During Endovascular Treatment of Critical Limb Ischemia. J Vasc Intervent Radiol 2023; 34(10): 1690-1696.

https://doi.org/10.1016/j.jvir.2023.06.033

17. Arjun B, Prijith R, Sreeraghu G, Narendrababu M. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian J Anaesth 2019; 63(8): 635.

https://doi.org/10.4103/ija.IJA_296_19

18. Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthoped 2022; 13(1): 11.

https://doi.org/10.5312%2Fwjo.v13.i1.11