Continuous Bupivacaine infusion of lumbar epidural VS Continuous 3 in 1 block for post operative analgesia following lower limb surgery - A comparative study

Dr. Prabir Pranjal Das; Dr Bandana Mahanta

Volume : VIII, Issue : XII, December - 2019

Continuous Bupivacaine infusion of lumbar epidural VS Continuous 3 in 1 block for post operative analgesia following lower limb surgery - A comparative study

Dr. Prabir Pranjal Das, Dr Bandana Mahanta

Abstract :

Peripheral nerve block provide effective analgesia with a lower incidence of autonomic side effects , less motor block and fewer serious neurological complications compared with epidural block. The present study was undertaken to compare continuous lumbar epidural(CEA) with continuous 3in 1 block (C3in1NB) for postoperative pain control in lower limb surgeries and also with commonly practiced systemic analgesic regime. Materials and Methods: Ninety patients of either sexes of ASA physical status I and II aged 18–65 years weighing after taking due consent were blindly randomized into three treatment groups. Patients received bupivacaine 0.125% via alumbar epidural catheter (placed preoperatively) for 24 hrs after surgery at a fixed rate of 5ml/hr( Group A) and via a catheter placed in the femoral sheath �Winnie Approach� preoperatively( Group B). Patients received parenteral analgesics post operatively (Group C). Data on Visual Analog Scale (VAS) pain scores, hemodynamic changes, side effects at 0, 1, 4, 8, 12, 18, 24 h and requirement of analgesic doses for the first 24 h of the surgery were noted. Results: Demographic data, surgical characteristics were comparable and statistically not significant in all the groups. In the groups CEA and C3in1NB, pain was well controlled, and statistically significant as compared to parenteral analgesic. The patients in CEA had more incidences of urinary retention. Procedure related failure rates were high in C3in1NB group. Conclusion: C3in1NB provides postoperative analgesia equivalent to that obtained with a CEA but with fewer side effects. However 3in1 block is difficult to perform with high failure rate and mostly sp� the obturator nerve.