Dexamethasone Adjunct in Ultrasound Guided Femorosciatic Block for Postoperative Analgesia

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Dexamethasone Adjunct in Ultrasound Guided Femorosciatic Block for Postoperative Analgesia

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Background and Aims: Since femoral sciatic block is not as famous as brachial plexus block for upper limb, and postoperative pain management in lower limb surgeries is limited to adjuvant in subarachnoid block or epidural analgesia. We intended to study the efficacy of ultrasound guided femorosciatic block in providing adequate postoperative analgesia, in patients undergoing below knee orthopedic surgeries. Also dexamethasone has been proved to be a useful adjuvant with local anesthetics in upper limb blocks, we considered to be studied in this block too. Methods and Materials: After approval of the institutional ethics committee, 65 patients planned for elective below knee orthopedic surgeries were enrolled in the study. Patients were randomly allocated to two groups: Group L and Group D. All the patients received subarachnoid block with 15 mg (3 ml) of 0.5% heavy bupivacaine for the surgery. In postoperative recovery room, when the level regressed to T10 level, ultrasound guided femorosciatic block was given. Group L received 20 ml of 0.25% levobupivacaine + 1 ml NS in femoral nerve block and 20 ml of 0.25% levobupivacaine + 1 ml NS in sciatic nerve block. The Group D received 20 ml of 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone in femoral nerve block and 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone in sciatic nerve block. In the postoperative period analgesia was given only on demand. The time of receiving first rescue analgesia was recorded along with the total number of rescue analgesics required in the 24 hours. The postoperative adductor muscle weakness and day of ambulation was also noted. Results: The demographic profiles of all the patients were similar. The postoperative analgesia was longer in Group D and also the number of rescue analgesics required in 24 hours was lesser in Group D. No patient had any block related or drug related side effects. Conclusion: Ultrasound guided femorosciatic block provides propitious postoperative analgesia in below knee orthopedic surgeries and can be used for providing postoperative analgesia in below knee orthopedic surgeries, without any side effects. Furthermore, adding dexamethasone to the block helps in prolonging the efficacy of the block by increasing the duration of analgesia provided and reducing the number of rescue analgesics required.

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