ULTRASOUND GUIDED SINGLE POINT VERSUS DOUBLE POINT POPLITEAL NERVE BLOCK FOR POST OPERATIVE ANALGESIA IN PATIENTS UNDERGOING FOOT SURGERIES

Abstract

Background: Popliteal nerve blockade is widely used for pain control after foot surgery. This study compared single point and double point ultrasound guided approaches to determine whether separate targeting of the tibial and common peroneal nerves improves postoperative analgesia. Methods: This prospective, randomized, double-blind, comparative study included 60 patients of age between 18–65 years with ASA physical status I–II undergoing elective foot surgery under spinal anaesthesia. Patients were allocated equally into two groups. Group SP received 20 mL of 0.5% isobaric levobupivacaine with fentanyl 25 μg as a single injection proximal to the sciatic bifurcation. Group DP received 10 mL of 0.5% isobaric levobupivacaine with fentanyl 25 μg separately around the tibial and common peroneal nerves. Duration of first rescue analgesia, rescue analgesic consumption, VAS scores, procedural time, haemodynamic variables, number of attempts, patient satisfaction and complications were assessed. Results: Duration of analgesia was significantly longer with DP than SP (962.54 ± 65.09 versus 746.81 ± 56.31 mins; p < 0.001). Rescue analgesic requirement was lower in DP (1.23 ± 0.55 versus 2.12 ± 0.55 doses; p < 0.001). VAS scores were significantly lower with DP at later postoperative intervals. Procedural time and haemodynamic parameters were comparable between groups. Repeated needle insertion and complications were infrequent, statistically not significant. Conclusion: Double point ultrasound guided popliteal blockade provided longer postoperative analgesia, lower pain scores and reduced rescue analgesic requirements compared with the single point approach, without increasing procedural time or complications.