Radhakrishan, A (2009) Comparison between Posterior and Lateral Approaches of Popliteal Block for lLower Limb Emergency Minor Surgical Procedures. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: The major responsibility of the anaesthesiologist is to provide adequate surgical anaesthesia and post operative analgesia for the patient with minimum complications. No anesthetic technique is successful and safe unless diligent efforts are made to have clear cut anatomical knowledge and proper administration technique. To accomplish adequate anaesthesia for foot surgeries we have general anaesthesia and regional anaesthetic techniques such as subarachnoid block, epidural block and various peripheral nerve blocks. Popliteal block is one of such peripheral nerve blocks. Popliteal block is used to block the Sciatic nerve at the popliteal fossa so that the region supplied by it distal to the site is anaesthetized. Successful popliteal block requires sufficient anatomical knowledge and special gadgets such as nerve locator apart from patient cooperation to avoid block failure and complications. An outstanding feature of nerve blocks including popliteal block is their lack of adverse effects1 as in general anaesthesia or neuraxial blockade and can give adequate post operative pain relief even if given in a single shot administration. Lignocaine, bupivacaine, ropivacaine and mepivacaine are commonly used local anaesthetic agents2. Lignocaine if used along with adrenaline and sodium bicarbonate can result in prolongation of the action apart from reduction of local anaesthetic toxicity. There are two approaches for popliteal block namely classical or posterior approach and lateral approach. Comparisons have been made between these two approaches for popliteal block administration. This study was carried out in the Department of Anaesthesiology, Government Stanley Medical College and Hospital, Chennai between August 2007 to August 2008. AIM OF THE STUDY: The aim of the study is to compare posterior and lateral approaches of popliteal block for lower limb emergency minor surgical procedures in respect to technical difficulty, patient comfort, branches of sciatic nerve stimulated, complications, onset and duration of action. MATERIALS AND METHODS: Patient Selection: Inclusion Criteria: A total of 60 patients18 undergoing foot and ankle surgeries were randomized into two groups, Group (P) for posterior approach and Group (L) for lateral approach after institutional ethical committee approval and informed consent to receive popliteal block using either the lateral or the posterior approach. All the patients who were selected belonged to American Society of Anaesthesiologist (ASA) Grade I and II (mild systemic disease that does not limit activity [II]. Informed consent to receive popliteal block explaining the complications of the technique was obtained. Exclusion Criteria: 1. All patients sensitive to Lignocaine, 2. Age less than 18 and greater than 70, 3. Obesity – surface landmark problems, 4. Weight < 40kg, 5. Patients with problems in positioning, 6. Contraindications for adrenaline, 7. Patient refusal, 8. Failure of block. Statistical Analysis: The sample of 60 group was taken for the study. Data was expressed as mean ± SD or absolute values. Qualitative analysis was compared with Chi square test and quantitative analysis was compared with student ‘t’ test. The level of statistical significance was set at p<0.05. The patient in each group was statistically comparable in distribution of age, weight ,height and sex distribution. SUMMARY: We assessed the outcome of popliteal block with posterior and lateral approaches in two groups of patients and the following observations were made: 1. There were no significant differences between two groups in demographic data. 2. Lateral approach is technically more difficult than the Posterior approach. 3. Lateral approach is more comfortable for the patient than the posterior approach. 4. Both approaches had no complications. 5. There were no significant difference in time of onset and duration of anaesthesia. CONCLUSION: Lateral approach of popliteal block has the advantage of less discomfort to the patient than that of the posterior approach with same quality of anaesthesia. Hence lateral approach of popliteal block is ideal for patients posted for foot surgeries where patient can be in supine position itself.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Posterior and Lateral Approaches ; Popliteal Block ; lLower Limb Emergency Minor Surgical Procedures ; Comparison Study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 15:56 |
| Last Modified: | 28 Apr 2018 06:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7241 |
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