PERINEURAL DEXAMETHASONE AS ADJUVANT TO LOCAL ANAESTHETIC AGENT IN ULTRASOUND GUIDED POPLITEAL NERVE BLOCK FOR VARIOUS ANKLE & FOOT SURGERIES

Background: Ankle& foot surgeries are very common surgeries in various age groups like young & geriatric as well as in patients with comorbidities.popliteal nerve block is one of multimodal Anaesthesia & analgesia for same.we have used ultrasound guided block to prevent complications &precise volume at asite for improving Charisteristics of block.

Aims of study: To study the technique of giving popliteal nerve blocks with ultrasonographic guidance and evaluate it in terms of: No of attempts ,Time required for sensory and motor blockade,Quality of Intra operative analgesia ,Duration for post operative analgesia , Supplementation required in form of general anaesthesia & Complications encountered.

Methods: We have given ultrasonography guided popliteal nerve block in 100 adult patients of ASA grade I/II/III undergoing foot and ankle surgeries. The volume of drug used was 20ml consisting of Lignocaine(1.5%) 10ml and Bupivacaine(0.5%) 10ml+ 2 ml Normal saline in Group A& addition of dexamethasone 8 mg as adjuvant to LA in Group B.

Results: The mean time taken to conduct the block was 4.3±1.4 mins in Group A,4.2±1.6 min inGr.B.The mean time taken for sensory onset was 3.8±1.1 mins in Gr A,3.6±1.4min in Gr.B .The mean time taken for motor onset was 7.2± 1.4 mins in GrA,7.0± 1.5 mins in Gr B.The mean time taken for completing the surgery was 39.2±5.0 mins in GrA,38.2±5.2 mins in Gr.B.The mean time taken for complete motor regression was 143.8±13.5 mins in Gr A,340.8±10.5 mins in Gr B.The mean time taken for complete sensory regression was 184.8± 16.8 minsin Gr.A,379.8± 18.8 mins in Gr B.(p<0.05)The patients first complained of pain at the mean time of 239±22.4 minsin Gr A,1069±12.4 minsin Gr B( p<0.001) In both groups,patients have stable haemodynamic parameters throughout the operation.supplementation of sedoanalgesia  was given in 4 patients in the form of Injection Midazolam 1mg IV and Injection Fentanyl 50 microgm IV was given in 2 patients and general anaesthesia was given in 2 patients in both groups.No other neurological complications were noticed in our study.

Conclusion: ultrasound guided Popliteal nerve block is safe& effective block for various ankle &foot surgeries. Dexamethasone is effective adjuvant in popliteal sciatic block for foot& ankle surgeries as it increase time to analgesic request.