Ages 18-80, ASA I-III, Patients Operated on Under Regional Anesthesia, Patients Scheduled for Elective Lower Extremity Surgery, Patients Who Provided Written Informed Consent
Conditions
Keywords
Lumbosacral Plexus, Anesthesia, Conduction, Postoperative Pain
Brief summary
The parasacral ischial plane block is a novel fascial plane approach targeting the sacral plexus. This technique is technically less challenging and eliminates the requirement for direct visualization of the sacral plexus. The aim of this prospective observational study is to evaluate the efficacy of the conventional sacral plexus block versus the parasacral ischial plane block in patients undergoing lower extremity surgery.
Detailed description
Sympatholysis resulting from central neuraxial block or general anesthesia in lower extremity surgeries may lead to adverse hemodynamic changes and increased perioperative mortality, particularly in high-risk patients. In such patients, lower extremity procedures can be successfully performed solely under sciatic and femoral nerve blocks. Depending on the surgical indication, the sciatic nerve block may be utilized alone or in combination with a lumbar plexus or femoral nerve block.A novel ultrasound-guided (USG) fascial plane approach targeting the sacral plexus, termed the Parasacral Ischial Plane (PIP) block, has been successfully investigated in a limited number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium bone laterally. The piriformis muscle has no attachment to the ischium; instead, it attaches laterally to the greater trochanter. A fascial plane exists between the piriformis muscle and the ischium, which extends directly to the sacral plexus. Venkataraju et al. stated that during the demonstration of the PIP block, the needle should be directed and positioned toward the posteromedial surface of the ischium. Following bony contact, the injectate was administered, and its spread was observed beneath the piriformis muscle toward the sacral plexus (SP). This method is considered to be technically more straightforward and carries a lower risk profile.
Interventions
PROCEDUREParasacral Ischial Plan Block
The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus. Venkataraju et al. stated that in PIP block demonstrations, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, the medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus.
PROCEDURESacral plexus block
This block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications.
Sponsors
Bursa Yuksek Ihtisas Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Intervention model description
Comparison of methods between 2 groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Ages 18-80 2. ASA I-III 3. Patients operated on under regional anesthesia 4. Patients who provided written informed consent 5. Patients scheduled for elective lower extremity surgery -
Exclusion criteria
1. Patients with a history of allergy to local anesthetic drugs 2. Patients with coagulation disorders 3. Patients with BMI \> 40 kg/m² 4. Presence of infection at the block application site 5. Chronic pain syndrome (chronic opioid use) 6. Pregnant women 7. Patients who cannot be communicated with 8. Patients requiring emergency surgery -
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sensory and motor block onset time | 1 hour | This approach is based on the volume-dependent spread of local anesthetic into the plane between the sacral plexus and the deep pelvic muscle fascia; sensory blockade begins proximally to distally within 10-20 minutes, while motor blockade usually develops later and gradually around 20-30 minutes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Numerical Rating Scale (NRS) | 1 Day | Pain control is a one-dimensional measurement tool, usually ranging from 0 to 10, used to subjectively assess a patient's pain intensity. In academic literature, this scale, expressed with integers from 0 (no pain) to 10 (the most severe pain imaginable), is considered a fundamental parameter for pain monitoring in clinical research and perioperative processes due to its high validity, ease of application, and flexibility in verbal or written form. |
Countries
Turkey (Türkiye)
Contacts
CONTACTNURULLAH DAMLA
CONTACTKorgün Ökmen, professor
STUDY_DIRECTORKorgün Ökmen
Bursa Yuksek Ihtisas Training and Research Hospital
Outcome results
None listed