Research Article
Volume 4 Issue 10 - 2020
Postoperative Analgesia in Lower Limbs Orthopedic Surgeries: A Comparative Study between Sciatic Nerve Block and Spinal Morphine
Luiz Eduardo Imbelloni1*, Marcelo de Araujo Pistarino1, Thaís Bezerra Ventura2, Eduardo Piccinini Viana1, Álvaro da Silva Oliveira Júnior3, Luana Miranda Souza3 and Geraldo Borges de Morais Filho4
1Anesthesiologist of Hospital Clínicas Municipal São Bernardo do Campo, SP, Brazil
2Anesthesiologist of Hospital Regional Wenceslau Lopes, Piancó, PB, Brazil
3Anesthesiologist Resident of Hospital Clínicas Municipal São Bernardo Campo, SP, Brazil
4Master in Labour Economics, UFPB, João Pessoa and Government Employee of the State of Paraíba, PB, Brazil
*Corresponding Author: Luiz Eduardo Imbelloni, Anesthesiologist of Hospital Clínicas Municipal São Bernardo do Campo, SP, Brazil.
Received: August 31, 2020; Published: September 28, 2020




Introduction: In our department, most anesthesiologists associate morphine with local anesthetic for analgesia in orthopedic surgeries. Sciatic nerve block with different approaches provides postoperative pain relief after below knee surgery. The purpose of this study is to compare the efficacy of single-shot sciatic nerve block for postoperative pain management in below knee orthopedic surgery compared to two doses of morphine.

Methods: Eighty adult patients, ASA I - II, scheduled for below the knee orthopedic surgery were included in the study. Patients were randomized into two equal groups. Both groups received spinal anesthesia as preferred by the anesthetist. Group I received sciatic block with neurostimulator and 40 ml of 0.25% bupivacaine for postoperative analgesia at the end of surgery and Group 2 received bupivacaine associated with 80 μg or 100 μg of morphine for spinal anesthesia. Data relating to surgical time, recovery time of motor block, need for catheterization, pain and treatments administered were recorded by an observer. Pain will be assessed in both groups using the visual analog scale (VAS) after complete recovery from spinal anesthesia. VAS will be assessed at 4h, 10h, 16h and 24h postoperatively. Patient satisfaction was assessed.

Results: There was no significant difference between both groups in demographic data. The visual analog scores of patients at each time point in the two groups showed significant difference. The incidence of urinary retention, itching, nausea and vomiting was not observed in patients with analgesia through sciatic nerve block. While with the use of morphine the incidence of urinary retention was 37.5%, itching 55% and nausea and vomiting 25%. The incidence of urinary retention was significantly higher with 100 µg compared to 80 µg of morphine. The duration of analgesia was significantly longer in group 1 and side effects more present in group 2. All patients in group 1 were satisfied with the postoperative analgesia technique, significantly higher than the 75% of patients with the use of morphine, reported by the inconveniences of side effects.

Conclusion: Sciatic nerve block with the neurostimulation technique provides longer duration of analgesic, lower incidence of side effects, higher incidence of satisfaction compared to the use of intrathecal morphine. There was no complication with the use of sciatic nerve block.

Keywords: Spinal Anesthesia; Sciatic Nerve Block; Bupivacaine; Neurostimulator; Morphine; Visual Analogue Scale

References

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Citation: Imbelloni LE., et al. “Postoperative Analgesia in Lower Limbs Orthopedic Surgeries: A Comparative Study between Sciatic Nerve Block and Spinal Morphine”. EC Emergency Medicine and Critical Care 4.10 (2020): 64-73.

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