A Comparison Of Combine Anesthesia Versus Spinal Anesthesia In Foot And Ankle Surgeries

Objective: Spinal anesthesia as a traditional anesthesia method was applied more than one hundred years and widely used in lower limb surgeries due to its cost effective, ease and related short learning curve. Over the past decade, regional anesthesia gradually showed its unique advantage with the application of ultrasound-guided technique in China. This study is committed to compare the traditional spinal anesthesia with combine anesthesia which included femoral nerve and sciatic nerve block guided by ultrasound combined and general anesthesia retaining spontaneous breathing in the foot and ankle surgeries.Methods: 80 ASA I patients undergoing foot and ankle surgeries were randomly divided into two groups, 40 patients in each group. The first group received spinal anesthesia(SA group) was performed by a single-injection technique using paramedian approach at the L3-4 interspace with a 26-gauge needle and injected 0.5% ropivacaine 25 mg in subarachnoid after free flow of cerebrospinal fluid. The second group received combine anesthesia(CA group) were performed ultrasound guided femoral nerve(0.5% ropivacaine 10 ml) and the sciatic nerve(0.5% ropivacaine 20 ml) block and combined with general anesthesia which induced with propofol 3 mg/kg and fentanyl 1ug/kg, followed by laryngeal mask airway insertion and 2%-2.5% sevoflurane for maintenance. The time of anesthesia preparation, onset, surgery, recovery, postoperative analgesia as well as the liquid taking and solid taking after surgery were recorded. At the same time, we also recorded the mean arterial pressure and heart rate at preoperative base status, and 0min,5 min, 10 min, 15 min, 30 min after induction of anesthesia, entering into the PACU and leaving the PACU. Additional data such as VAS score, post-anesthesia complication and patient satisfaction evaluation were collected by an anesthesologist blinded to the study goals at postoperative 24 h, 48 h, 72 h.Results: The time of anesthesia preparation, intake of fluids and solids in CA group is shorter than that in SA group, otherwise the time of PACU, surgery, sensory and motor block is longer. The heart rate of CA group at 5min, 10 min, 15 min post anesthesia are lower than that in SA group, so as the MAP at immediately, 5min and 15 min post anesthesia. The VAS scores of CA group at postoperative 24 h, 48 h, 72 h are lower than the SA group. Patient satisfaction score of CA group is significantly higher than SA group.Conclusion: The combine anesthesia can improve the effect of postoperative analgesia, extend the time of postoperative analgesia, shorten the time of postoperative fasting, and improve patient satisfaction. Femoral nerve and sciatic nerve block guided by ultrasound combined with general anesthesia retaining spontaneous breathing in the foot and ankle surgeries has broad application prospect. Since the learning curve is long and achieve the aim of the combined anesthesia is difficult, and therefore proposed new challenge for orthopedic specialist anesthesiologists.