Title: Femoral Nerve Block versus Spinal Anesthesia for Lower Limb Peripheral Vascular Surgery
Abstract: Perioperative cardiac complications occur in 4% to 6% of patients undergoing infrainguinal revascularization under general, spinal, or epidural anesthesia. The risk may be even greater in patients whose cardiac disease cannot be fully evaluated or treated before urgent limb salvage operations. Prompted by these considerations, we investigated the feasibility and results of using femoral nerve block with infiltration of the genito4femoral nerve branches in these high-risk patients. Methods: Forty peripheral vascular reconstruction of lower limbs were performed under either spinal anesthesia (20 patients) or femoral nerve block with infiltration of genito-femoral nerve branches supplemented with local infiltration at the site of dissection as needed (20 patients). All patients had arterial lines. Arterial blood pressure and electrocardiographic monitoring was continued during surgery, in PACU and in the intensive care units. Results: Operations included femoral-femoral, femoral-popliteal bypass grafting and thrombectomy. The intra-operative events showed that the mean time needed to perform the block and dose of analgesics and sedatives needed during surgery was greater in group I (FNB,) compared to group II [P=0.01*, P0.029* , P0.039*], however, the time needed to start surgery was shorter in group I than in group II [P=0. 039]. There were no block failures in either group, but local infiltration in the area of the dissection with 2 ml (range 1-5 ml) of 1% lidocaine was required in 4 (20%) patients in FNB group vs none in the spinal group. The recovery times showed that the nerve block resolution and time to micturition was longer [P0. 0001 [p=0.0001*, p=0.00032*] in the Spinal group (group II) as compared with patients receiving femoral nerve blockade (group I). Moreover, the incidence of pain requiring analgesics in PACU and postoperative complications was higher in group II than in group I [P0.021*, p0.0028*]. Conclusion: lower limb vascular reconstruction can be done under local anesthesia (femoral nerve block with infiltration of genitor-femoral nerve branches) with acceptable complication rates specially in patients with high-risk diseases.
Publication Year: 2006
Publication Date: 2006-01-01
Language: en
Type: article
Access and Citation
Cited By Count: 12
AI Researcher Chatbot
Get quick answers to your questions about the article from our AI researcher chatbot