Comparison of the effectiveness of fascia iliaca block plus popliteal block on thigh tourniquet pain in below- knee orthopedic surgery compared with spinal anesthesia

To determine the effectiveness of fascia iliaca block on thigh tourniquet pain during unilateral below-knee orthopedic surgeries

A two-arm parallel, randomized controlled clinical trial with concealed randomization sequence and blinded outcome assessment.

72 patients are recruited from Akhtar hospital affiliated to Shahid Beheshti University of Medical Sciences after obtaining informed consent. They are randomly divided into two equal groups of spinal anesthesia and fascia iliaca block by a blinded investigator. When a satisfactory block is achieved, a pneumatic thigh tourniquet is inflated in the proximal part of the thigh. The tourniquet pain is assessed by a blinded observer immediately after tourniquet inflation and then every 5 min until the end of surgery with a 5-point verbal rating scale (VRS). If the patient complains of pain or VRS >1, bolus doses of intravenous fentanyl or ketamine are given alternatively. If inadequate, general anesthesia is performed.

Inclusion criteria: AَُSA 1 or 2 patients, aged 14 to 80 years, scheduled for unilateral below-knee orthopedic surgery using a pneumatic thigh tourniquet. Exclusion criteria: Patients with allergy to local anesthetics, coagulation disorders, opium addiction, infection at the block site, previous femoral or popliteal bypass surgery, BMI more than 30, sickle cell anemia, tourniquet inflation time less than 60 minutes, and lack of cooperation.

In the patients in the control group, the standard method of spinal anesthesia is performed. In the Intervention group, fascia iliaca and popliteal blockades are performed under the guidance of ultrasound

Severity of tourniquet pain during surgery; time to perform the block; anesthetic effect time; total doses of analgesics given intraoperatively.

We used a simple random sampling method using a table of random numbers to generate a random sequence of patients. even numbers were considered for the peripheral nerve block group and odd numbers for the spinal anesthesia group. The researcher then touches one of the numbers in the table of random numbers and moves in the right direction of the table, recording the numbers and assigning them to two groups. Each random sequence is recorded on a card. When the eligible participants enter the study, the cards are selected in order of their sequence.

Randomization, assignment of patients in each group, and random selection of envelopes is done by an investigator with no involvement in the trial. The person who measures the outcomes is also kept blinded.

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