Comparison of Peripheral Nerve Blocks, Spinal Anesthesia and General Anesthesia for Ambulatory Surgery of the Lower Limb

Abstract

Objective: Our study has been performed to compare effects of peripheral nerve block, spinal anesthesia and general anesthesia on anesthesia application, anesthesia and analgesia quality and patient and surgeon satisfaction in ambulatory under-knee extremity surgery. Material and Method: 64 ASA(American Society of Anesthesiologists) I-II patients were randomly divided into peripheral nerve block (Group PSB, n=23), spinal anesthesia (Group SA, n=21) and general anesthesia (Group GA, n=20) groups. All patients were given premedication. Sciatic+femoral (n=8), popliteal+saphenous (n=8) and ankle blocks (n=7) were applied in PSB (peripheral nerve block) group according to extremity region where surgery was applied and tourniquet was placed. Unilateral spinal anesthesia with 15 mg 0.5% hyperbaric bupivakain was applied in SA group. Anesthesia induction was performed with propofol and fentanyl in GA group, and sevofluran was administered as maintenance after insertion of laryngeal mask airway (LMA). Petidin was used for postoperative analgesia. Pain was evaluated by using visual analog scale (VAS), and intraoperative fentanyl and postoperative lornoksikam were used as rescue analgesic. Finally vital signs, termination time of motor and sensory block, additional sedation and analgesia, time until first requirement for analgesic, patient and surgeon satisfaction were evaluated. Results: Anesthesia procedure and time for being ready for surgery after the procedure were longer in PSB group than SA and GA groups; and time for leaving post-anesthesia care unit (ASBU) was shorter than SA and GA groups (p<0.001). Again, motor and sensory block lasted longer in PSB group compared to SA and GA groups. First requirement for analgesic was later and less analgesic was consumed (p<0.001). Patient satisfaction was more in PSB group (p<0.001) while surgical satisfaction was similar Conclusion: We think that PSB may be more reliable and effective method than general and spinal anesthesia in ambulatory lower extremity surgery due to it provides better analgesia and anesthesia, later appearance for first requirement for analgesics and lower analgesic consumption, it provides high percentage of patient satisfaction and ease of application.