THE CLINICAL EFFICACY OF SCIATIC NERVE BLOCK BY LATERAL APPROACH FOR THE OSTEOSYNTHESIS OF FRACTURES LEG AND FOOT

Abstract

BACKGROUND. For sciatic nerve blockade using the rear, front and lithotomy accesses. Wide application of these approaches in the clinic hinder the necessity of a certain body position, technical difficulty, high failure rates and complications. The aim of the study was to evaluate the clinical efficacy of blockade sciatic nerve lateral approach at osteosynthesis of bone fractures leg and foot. METHODS: 110 patients with fractures of the lower legs or feet were enrolled in our study. Patients were randomly allocated into two groups. Blockade of sciatic nerve in the first group (n = 68) was performed from a lateral approach, the second group (n = 42) - from the anterior approach. In both groups, the manipulation using ultrasound guided and neurostimulation was performed. A fixed the execution of blockade, its success, intensity of pain, hemodynamic monitoring, acute stress markers, and drug load on the system analgesia. RESULTS: The duration of performance of the blockade in the first group was 2,36 ± 0,1 min, the second group - 4,67 ± 0,2 min (P <0.05). It was unsuccessful blockade in the first group in 2 (2.9%) patients in the second group - in 6 (14.3%) patients (P <0.05). The blockade of the sciatic nerve structures protects the central nervous system from of operative stress. The intensity of pain during the operation and two days of the postoperative period in patients in the first group was significantly (P <0.001) lower than a second group. In postoperative period dose of ketoprofen was in the first group - 23,5 ± 0 5 mg, in the second group - 114,3 ± 12,8 mg (P <0.001), the administration of promedol was shown in 3 (4.4%) and in 9 (21.4%) patients (P <0.001), respectively. Complications were found in the first group in 3 (4.4%) patients in the second group - in 9 (21.4%) patients (P <0.001). CONCLUSIONS: The blockade of the sciatic nerve lateral approach at osteosynthesis of fractures of the lower leg and foot is a simple process, eliminates the special placement of the patient, safe and efficient.

Keywords

lower leg and foot fractures / regional anesthesia / sciatic nerve blockade

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