THESIS TITLE-

Novel vs Traditional :  comparison of 4-1 block vs epidural for post operative analgesic needs in knee and below knee surgeries.

Knee and below knee surgeries are associated with moderate to severe pain postoperatively leading to delayed recovery and  prolonged hospital stay. Therefore, this study is to compare two types of analgesia. Aim of our study is to compare post-operative analgesia and motor performance between 4-1 Block versus Continuous Epidural Block (CEB) in patients undergoing Knee and below Knee surgeries. Patient will be evaluated on primary outcomes such as duration of post-operative analgesia, total dose of rescue analgesic required in first 24 hours, VAS (Visual Analog Scale) score at  2, 4, 6, 12, 24 hours post-operatively .The secondary outcomes will be to analyze the incidence of complications if any, to assess the side effects of drug used and length of hospital stay. Total 80 patients will be taken and they will be divided randomly into 2 group of 40 each.

Group A-  4-1 BLOCK GROUP : After surgery, supine position is maintained and the vastus medialis muscle is identified by ultrasound. Then scanned proximally till the intersection of vastus and sartorius. Then the probe is slid proximally till the superficial femoral artery appears in the adductor hiatus.. The probe is then again slid slowly proximally till the descending genicular artery , a branch from superficial femoral artery is visualised in the adductor hiatus. Further proximally where descending genicular artery disappears is the point of injection. The point is 8-10 cm above the femoral condyle. Under all aseptic precautions, a 22 gauge, 360 ultrasound compatible 100 mm needle is guided in plane from lateral to medial side under ultrasound guidance to reach perivascular regions and after negative aspiration , 0.2% ropivacaine 35 ml along with 0.5 mcg/kg Dexmedetomidine is injected that is visualised to push the femoral artery posteriorly.

 Group B- EPIDURAL BLOCK GROUP : Non ultrasonographic guided Epidural block with bolus dose of 5ml 0.2% Ropivacaine with  0.5mcg/kg Dexmedetomidine will be given followed by the same dose and concentration of the drug as Continuous Epidural Block infusion at rate of 5ml/hour.

After the blocks, vital parameters will be monitored and recorded. Side effects will be observed, if any. Visual Analogue Scale score will be noted at 2, 4, 6, 12 & 24 hours. Length of hospital stay after the surgery will be noted. All the data will be recorded.