Buprenorphine Vs Clonidine as Adjuvant for Ultrasound Guided Popliteal Sciatic Nerve Block in Lower Limb Surgeries a Double Blinded Randomised Study

Abstract

Background: and aims: The aim of the study was to compare the effectiveness of ultrasound-guided popliteal nerve block with two different additives with 2% xylocaine adrenaline in below knee surgeries. The primary objective is to determine the duration of effect of ultrasound guided popliteal sciatic nerve block with dose of 15 ml 2% lignocaine with additive buprenorphine and 15 ml of 2%lignocaine with clonidine, to find out the onset and duration of anaesthesia, and to determine the requirement of tramadol as rescue analgesia in the first 24 hours.

Materials and Methodology: Sixty-eight patients were selected, randomized, and grouped into two. Patients under ASA1 and ASA 2 and ASA 3 scheduled to undergo elective and emergency below knee surgeries were included. In Group A participants, using high frequency ultrasound,a 23-G quincke needle is introduced at least 7-cm superior to the popliteal crease. With the probe parallel to the popliteal crease and at a level proximal to the nerve split, the needle is inserted at the lateral aspect of the probe and advanced toward the nerve. After the sciatic sheath is penetrated and the nerve is stimulated, inject 16 mL of 2% xylocaine with adrenaline and clonidine 0.5ml. In Group B participants, using high frequency ultrasound, a 23-G quincke needle is introduced at least 7-cm superior to the popliteal crease and approximately 1 cm lateral to the apex of the popliteal triangle, 16 mL of 2% xylocaine with adrenaline, Buprenorphine 0.5ml is injected. Comparison between the two groups with regard to age, sex, ASA classification, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, VAS at rest, VAS at movement, requirement of tramadol and duration of block distribution were analyzed.

Results: Age, sex, ASA classification, and pain outcomes were similar between both groups.Buprenorphine as additive,showed improved onset times, extended analgesia duration, and fewer rescue analgesics were similar in both groups as well. Both Groups exhibited similar fluctuations in heart rate and systolic blood pressure, suggesting some external influences on these parameters. Both groups maintained stable oxygen saturation, and no significant safety concerns or complications were observed.

Conclusion: Buprenorphine as additive with 2% xylocaine in ultrasound popliteal nerve blocks can improve anesthetic effectiveness, reduce rescue analgesic needs, and prolong block duration without compromising safety. Both groups showed similar baseline characteristics, confirming the potential benefits of volume adjustments in regional anesthesia