Combination of Sacral Spinal Anesthesia and Popliteal Fossa Block on Surgical Side for Below Knee Surgery

Background: The beneficial effects of two central neuraxial blocks in combined form are well acceptable and well tolerable by patients. Beneficial effects of both components are utilized, minimizing their drawbacks. Aims: Our study is designed to evaluate the use of peripheral ( popliteal fossa block ) and central nerve block (spinal) in combined form for below knee surgical procedures. Methods: 30 patients of 60-90 years old with ASA physical status of classification II and III were selected for below knee surgical procedures undergoing popliteal fossa block 20 minutes before sacral spinal anesthesia. The popliteal fossa block was achieved with 30 ml of o.375% injection bupivacaine through lateral approach at the level of upper broader of patella with help of nerve stimulator needle. Sacral spinal anesthesia was introduced through second dorsal foramen of sacrum by intrathecal administration of three ml of 0.5% injection bupivacaine. Results: The hemodynamic stability along with profound and prolonged analgesia before, during and after surgical procedure is the most interesting characteristic feature of this study. Preoperative popliteal fossa block induces analgesic effect at the fracture site and contributes comforts to patients at the time of positioning the patient for administration of sacral spinal anesthesia. It acts as an adjuvant to spinal anesthesia like intrathecal administration of fentanyl or clonidine with the central depression. Conclusion: It provides analgesia before spinal as preoperative medication without central depression, cardiovascular stability during surgical procedures under spinal anesthesia and prolonged analgesia after surgery.