The study will be a type
of prospective randomised controlled trial undertaken in adult patients of 18
to 70 year of age admitted in SSG hospital requiring lower leg surgery with a
sample size of 60 patients.
Pre-operative
Preparation:
•
Patient to be kept nil by mouth(NBM) for minimum 6-8 Hours.
•
Patient will be explained about VAS score preoperatively.
•
Operation theatre preparation for all necessary equipments and drugs to be kept
ready.
•
Anesthesia machine with monitor to be kept ready.
•
IV line will be taken with 18G cannula.
Premedication:-
ON THE DAY BEFORE
SURGERY
Tab Ranitidine 150
mg PO 1 HS
ON THE DAY OF SURGERY
5 Minutes before induction:
Inj.
Glycopyrrolate 0.2 mg IV
Inj.
Ondansetron 4 mg IV
Anesthesia
method:
INDUCTION
OF ANAESTHESIA:
The
patients will be randomly allocated into two groups by sealed envelope method.
Grouping
of Patients:
•
Group P(N=30)
Patients
will be given Popliteal Sciatic Block +
Adductor Canal Block (Drug to be used:- 0.5% Bupivacaine 20 ml + 2% Lignocaine 20ml with 5mcg/ml
1:200000 Adrenaline and Sodabicarbonate 2ml)
•
Group S(N=30)
Patients
will be given Unilateral Spinal Anesthesia with Inj. Bupivacaine Heavy 0.5%
1ml.
Ø Injection Midazolam 1mg/kg will be given in
all the patients after procedure.
Technique
For Popliteal Sciatic Block:-
Position:
Supine with Hip Flexed at 30* by putting pillow below the heel and Knee Fully
Extended.
The
landmark for needle insertion is approximately 10cm above the Most Prominent
part of Lateral Femoral Condyle in the groove between Biceps Femoris and the vastus Lateralis muscle.
Nerve
Locator Technique: In proposed study we will use this technique.
•
A22-gauge 8-inch insulated needle is attached to the negative electrode of the
PNS. The extension tubing is primed and attached to a syringe filled with local
anesthetic solution.
•The
initial current strength is set at 3mA with 2Hz frequency and 0.1ms duration.
•
The needle is inserted in the groove between the Biceps Femoris and Vastus
lateralis by palpating it with finger tips and is directed perpendicular to the
skin till the Planter Flexion of Foot is elicited.
•
Amplitude to be decreased up to 0.5 mA while seeking maximal Planter Flexion
contraction. If necessary needle should be relocated to achieve adequate
contraction while reducing amplitude. If there is continued Planter Flexion
contraction when at 0.2 mA or less withdraw needle. Stimulation at this low
level may indicate intraneural placement of the needle.
•
After the injection of 1 ml of local anesthetic the contractions should start
to fade.
•
Always aspiration should be done before injection, during injection and after
injection to ensure that inadvertent intravascular injection has not occurred.
If the aspiration for blood is negative, 21ml local anesthetic is injected.
•
If the patient experiences excruciating pain or parasthesia with injection
withdraw the needle slightly.
•
Complete effect of the block will be achieved in 20 minutes.
Technique
For Adductor Canal Block
Position:
Supine. A pillow will be placed under the knee and thigh.
The
landmark for needle insertion is approximately 4 finger breadth (7 -8 cm) above
the adductor tubercle on the medical condyle of the femur in the groove between
Sartorius and the vastus medialis muscle
The
groove is also known as the Jobert’s fossa.
Nerve
Locator Technique: In proposed study we will use this technique.
•
A22-gauge 8-inch insulated needle is attached to the negative electrode of the
PNS. The extension tubing is primed and attached to a syringe filled with LA
solution.
•The
initial current strength is set at 3mA with 2Hz frequency and 0.1ms duration.
•The
block is best done by standing on the opposite side to the block site.
•
The needle is inserted in the groove between the vastus medialis and Sartorius
by palpating it with finger tips and is directed perpendicular to the skin with
slight posterior angulation till the contraction of vastus medialis muscle is
elicited.
•
Amplitude to be decreased up to 0.5 mA while seeking maximal vastus medialis
contraction. If contractions are fading while reducing amplitude, needle should
be relocated to achieve adequate contraction.
If there is continued vastus medialis contraction when at 0.2 mA or less
withdraw needle. Stimulation at this low level may indicate intraneural
placement of the needle.
•
After the injection of 1 ml of local anesthetic the contractions should start
to fade.
•
Always aspiration should be done before injection, during injection and after
injection to ensure that inadvertent intravascular injection has not occurred.
If the aspiration for blood is negative, 21ml local anesthetic is injected.
•
If the patient experiences excruciating pain or paresthesia with injection
withdraw the needle slightly.
•
Complete effect of the block will be achieved in 20 minutes.
Technique
For Unilateral Spinal anesthesia
Position:
Lateral (Operative site to be in lower side)
Under all aseptic and antiseptic
precaution spinal anesthesia should be given in L3-L4 space with 23G spinal
needle with injection 0.5% Bupivacaine Heavy 1ml. Patient kept in lateral
position for 10 minutes. |