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Study Papers | Anaesthesiology | India | Volume 12 Issue 2, February 2023

Safety and Efficacy of Combined Lumbar Plexus, Sciatic Nerve, Femoral Nerve Blocks in Failed Spinal Anaesthesia for Lower Limb Surgeries: A Prospective Clinical Study

Dr. Katti Lavanya | Dr. A. Naveen Kumar | Dr. T. Madhusudhan | Dr. Murali Prabhakar ^[2]

Abstract: Introduction: In patients with failed spinal anaesthesia for lower limb surgeries often carries high risk with General anaesthesia due to presence of high risk factors for General anaesthesia like severe Chronic obstructive pulmonary disease [COPD], Ischemic heart disease, cardiomyopathies, valvular heart disease, difficult intubation. In order to decrease the risk of anaesthesia for surgery, we have evaluated alternative technique of anaesthesia for lower limb surgeries in failed spinal anaesthesia cases. Aims & Objectives: The aim of the study was to evaluate safety and efficacy of combined Lumbar plexus, sciatic nerve, femoral nerve for lower limb surgeries and to assess efficacy of providing surgical anaesthesia, incidence of intraoperative complications, postoperative complications and benefits. Materials & Methods: In the present study, 50 patients of failed spinal anaesthesiaof age group between 20 - 80yrs of age were taken. In all the patients with failed spinal anaesthesia, Combined Lumbar plexus, Sciatic nerve, femoral nerve blocks were performed. Local anaesthetic solution of 40ml of 0.5% Ropivacaine is used for achieving combined nerve blocks.8mg Dexamethasone was added to local anaesthetic as an adjuvant to prolong the duration. . To allay anxiety, Inj 1mg midazolam was given intravenously prior to the block and intravenous Butorphanol Tartarate was given before starting of surgery as a opioid analgesic for intraoperative analgesia. A total of 24 patients were ASA group I, 16 patients were ASA group II, 6 patients were ASA group III. Results: Time of onset of block required for surgical anaesthesia was noted. Incidence of Regional nerve complications like unconsciousness, local anaesthetic systemic toxicity, respiratory arrest was noted. No patient reported about regional nerve block complications. Out of 50 patients 8 patients required intraoperative supplementation TIVA with propofol. There were no intraoperative complications noted during the study. Postoperatively patients had a longer pain free relief. Opioid analgesic were required in lower doses in postoperative period, due to prolonged duration of regional nerve blocks, which caused lower incidence of postoperative complications like nausea & vomiting. Conclusion: The study confirms combined lumbar plexus, sciatic nerve, femoral nerve block in failed spinal anaesthesia is a very good appropriate alternative technique to General anaesthesia in patients with failed spinal who are scheduled for lower limb surgeries. The study highlights advantages of combined lumbar plexus, sciatic nerve, femoral nerve having low morbidity and mortality over general Anaesthesia in patients with high risk factors in failed spinal anaesthesia.

Keywords: Lumbar plexus block, sciatic nerve block, femoral nerve block, failed spinal anaesthesia, Ropivacaine

Edition: Volume 12 Issue 2, February 2023,

Pages: 1427 - 1432