Sciatic obturator femoral technique versus spinal anesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator: A randomised trial

Background Peripheral nerve block is an ideal choice for lower limb surgery because of the peripheral site of the surgical procedure and the ability to block pain pathways at multiple levels. The aim of this study was to assess the efficacy and safety of SOFT (sciatic-obturator-femoral nerve block technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator Methods This study was conducted over 107 patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7.5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, time of first analgesic dose, visual analogue scale scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic, paresthesia observed within 48 hours of the block. Results The duration of soft block and time to first analgesic dose in SOFT group was significantly longer (p<0.001). The incidence of headache (p=0.028) and back pain (p=0.012) was significantly higher in spinal group. There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and parathesia. Pain scores were significantly lower in SOFT group at 3,6,12 hours postoperative (p<0.001).Time to the first effect was significantly longer in SOFT (P<0.001). Conclusion Our results showed that SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing elective fixation of tibial fractures using Ilizarov external fixator.