Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery

Abstract:

Objective To investigate the effects of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery.Methods Sixty-nine elderly patients，scheduled for elective foot surgery，were randomized into 3 groups：subarachnoid block combined with thigh tourniquet group（group C），subarachnoid block combined with ankle tourniquet group（group SA），adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet group（group NA）. The peak changes of mean arterial pressure（MAP） and heart rate（HR） during 30 min after anesthesia，and changes of MAP and HR at 1 min，3 min，5 min，10 min and 15 min after tourniquet deflation；postoperative micturition and flatus passage time，quality of recovery-15（QoR-15） score 24 h after operation；effects of anesthesia and surgical field hemostasis，dose of metaraminol，time of patient-controlled analgesia（PCA） initiation and consumption of sufentanil within 48 h after operation and adverse reactions were compared among the three groups.Results Sixty-nine patients were enrolled in the study，and sixty-four completed the study. Compared with group C and group SA，the peak changes of MAP and HR during 30 min after anesthesia of group NA were significantly lower. In addition， the postoperative micturition and flatus passage time were shortened，and QoR-15 score 24 h after operation was higher. The onset of anesthesia was slower，region of blockade was smaller，less metaraminol was used，time of PCA initiation was longer，and cumulative consumptions of sufentanil were less at 12 h，24 h and 48 h after operation in group NA. All the differences were statistically significant（P<0.05）. Compared with group C，the amplitudes of MAP and HR changes in group SA and group NA after tourniquet deflation were significantly smaller with less metaraminol. Moreover，the incidences of skin blisters and pain in tourniquet area were significantly lower after operation（P<0.05）. There were no significant differences in other indexes among the three groups（P>0.05）.Conclusion Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery could bring stable hemodynamics，enhanced recovery， favorable effects and few adverse reactions.