Effect of Peripheral Nerve Blocks as anesthetic adjuvant with Spinal versus General anesthesia on pain control and early postoperative discharge

Gad, Gad Sayed; Esmail, Almoutasem Gaafer Ahmed; Ahmed, Mohammed Gaber

doi:10.21608/svuijm.2023.232739.1671

Effect of Peripheral Nerve Blocks as anesthetic adjuvant with Spinal versus General anesthesia on pain control and early postoperative discharge

Document Type : Original research articles

Authors

Department of Anesthesia, ICU, and Pain Management, Faculty of Medicine, South Valley University, Qena 83523, Egypt

10.21608/svuijm.2023.232739.1671

Abstract

Background: Spinal anesthesia may cause many side effects. Augmenting it with Peripheral nerve blocks reduce opioid use. Proficient neuroaxial blocks may cause hyperalgesia. Pain relief and recovery are improved with peripheral nerve blocks.
Objectives: To assess peripheral nerve blocks impact with spinal compared to with general anesthesia on sever post operative pain and early discharge.
Patients and methods: This randomized trial divided 60 foot and ankle surgery patients into two groups: A: spinal anesthesia with Popliteal PNBs, B: general. Ages 20-55, ASA 1 or 2, 1-3 hour surgeries. Age >55, allergies, ASA 3 or 4, pregnancy/breastfeeding excluded. History, examinations, lab tests, anesthetic, surgical records. The ethical clearance number is SVU-MED-AIP029-1-22-9-454. Main outcomes: VAS score, opioid usage; secondary outcomes: hospital stay, nausea/vomiting, PACU discharge time.
Results: Group A: mean age: 44.6±7.03 years, 53.3% male. In Group B, mean age: 46.27±8.18 years, 66.7% male. Non-significant gender or age differences (p>0.05). Surgical kinds similar (p>0.05). ASAII classification higher in Group A (86.7% vs. 53.3%, p=0.005). No significant VAS score differences at 4, 8, 12, and 24 hours (p>0.05). Group A (1.33±0.48 days, 20% opioids) and Group B (1.43±0.73 days, 6.7% opioids) had comparable hospital stays (p>0.05). On average, Group A discharged at 55.53±5.26 minutes with no nausea or vomiting occurrence, whereas Group B discharged at 32.60±3.34 minutes but, 93.3% of cases reported nausea or vomiting. The average PACU discharge time was 44.07±12.36 minutes (range 28-66 minutes).
Conclusion: general anesthesia led to faster PACU discharge but not overall discharge, lower postoperative pain levels, suggesting both approaches are viable for foot and ankle surgery.

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