Research Article

Comparative Effectiveness of Combined Lumbar– Para Sacral Nerve Block and Spinal Anaesthesia on the Pain Intensity and Duration of Anaesthesia in Patients with Tibial Fracture

Abstract

Background: The aim of this study was to evaluate the effect of combined lumbar plexus – para sacral nerve block (LP/NB) and spinal anaesthesia (SA) on the duration and intensity of postoperative pain in patients with Tibia fracture requiring surgery.
Methods: In this clinical trial, 40 patients with tibial fractures requiring surgery, who were admitted to a referral hospital in north-eastern Iran from 2020 to 2021, and randomly subjected to LP/NB or spinal anaesthesia. Pain intensity and duration of anaesthesia in the two groups were compared based on a numerical rating scale within 4, 6 and 12 hours from the induction of anaesthesia. Clinical demand for analgesics following surgery was also recorded. Data were statistically analysed with IBM SPSS.
Results: The mean age of participants was 37.4 ±14.4, with 29 (72.5%) and 11 (27.5%) male and female patients, respectively. There were no significant differences in age and sex ratio between the two groups. The mean pain intensity within 4 hours from surgery was lower in the LP/NB group, however, this difference was not statistically significant (p-value: 0.054). Likewise, there were also no significant differences between the values reported for 6 (p-value: 0.303) and 12-hour (p-value: 0.523) post-surgery pain intensity for each group. Overall, the mean pain intensity at any given time was not significantly different between the two groups of LP/NB and SA (p-value: 0.671).
Conclusion: There was no significant difference between the two groups in terms of mean pain intensity at 4, 6 and 12 hours after the onset of the block. No side effects were observed in any of the patients.

[1] Zhang Z, Yang Q, Xin W, Zhang Y. Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty. Medicine (Baltimore). 2017; 96(19): e6829.
[2] Álvarez NER, Ledesma RJG, Hamaji A, Hamaji MWM, Vieira JE. Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: A randomized trial. BMC Anesthesiol. 2017; 17(1):64.
[3] Bareka M, Hantes M, Arnaoutoglou E, Vretzakis G. Superior perioperative analgesia with combined femoral–obturator–sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery. Knee Surg Sports Traumatol Arthrosc. 2018; 26(2):478–84.
[4] Joe HB, Choo HS, Yoon JS, Oh SE, Cho JH, Park YU. Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery. Medicine (Baltimore). 2016; 95(52):e5758.
[5] Ho AMH, Karmakar MK. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis. Can J Anesth. 2002; 49(9):946–50.
[6] Pourbahri M, Kashani S, Melekshoar M, Jarineshin H, Vatankhah M, Baghaee A, et al. Comparison of Median Vs. Paramedian Techniques of Spinal Anesthesia in Cesarean Section. Anesthesiol Pain Med. 2015; 6(1):9–20.
[7] Kumar DP, Kaushik DA. Orthopedic Surgeries of Lower Limb under Combined Femoral and Sciatic Nerve Block: A Comparative Study in RMCH & RC. Int J Innov Res Med Sci. 2018; 3(05):2024 to 2027.
[8] Petchara S, Paphon S, Vanlapa A, Boontikar P, Disya K. Combined lumbar-sacral plexus block in high surgical risk geriatric patients undergoing early hip fracture surgery. Malaysian Orthop J. 2015; 9(3):28–34.
[9] Abouleish AE, Leib ML, Cohen NH. ASA Provides Examples to Each ASA Physical Status Class. ASA Monit. 2015; 79(6):38–49.
[10] Lammers C, Wyckaert C. Anesthesia for orthopedic surgery. In: Gregory’s Pediatric Anesthesia: Fifth Edition. 2011. p. 757–76.
[11] Bakı ED, Taşkapılı K, Akıcı ÖÇ. Application of femoral+ sciatic block in high risk patients: Two cases. Int J Innov Surg. 2019; 2(1):1006.
[12] Hashemi SM, Vahid Farahmandi M, Razavi SS, Hosseini Khameneh SM, Kazemi SM, Safdari F. The Effect of Continuous Femoral Nerve Block on Pain after Total Knee Arthroplasty. Iran J Orthop Surg. 2012; 10(4):181–5.
[13] de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med. 2000; 25(2):158–62.
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IssueVol 9 No Supp. 1 (2023): Supplement 1 QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i5.13951
Keywords
Nerve block Fracture Anaesthesia

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How to Cite
1.
Mokarram Dori M, Dehghan Tafti F, Bameshki A, Ziaee M. Comparative Effectiveness of Combined Lumbar– Para Sacral Nerve Block and Spinal Anaesthesia on the Pain Intensity and Duration of Anaesthesia in Patients with Tibial Fracture. Arch Anesth & Crit Care. 2023;9(Supp. 1):375-379.