Lumbosacral Erector Spinae Plane Block Versus Psoas Muscle Compartment with Sciatic Nerve Block for Anesthesia for Unilateral Lower Limb Operations in Critically Ill Patients: A Randomized Open-Label Study

Abstract

Background: Regional anesthesia techniques have gained popularity for lower limb (LL) surgeries. The psoas compartment block (PCB)-sciatic nerve block (SNB) combination effectively anesthetizes the entire lower extremities while providing greater hemodynamic stability. The combined lumbosacral erector spinae plane block (LS-ESPB) has shown promise in providing effective analgesia for various surgical procedures by targeting both the lumbar and sacral regions. Objectives: This investigation compared the outcomes of the LS-ESPB and the PCB combined with the SNB for unilateral LL anesthesia. Methods: This randomized open-label study involved 130 critically ill patients, of both sexes, aged 18 - 65 years, undergoing unilateral LL operations. Participants were randomized equally into two groups. Group A received ultrasound (US)-guided lumbar erector peripheral nerve block (LESPB, 20 mL) and sacral erector peripheral nerve block (SESPB, 40 mL), and group B received US-guided PCB (20 mL) combined with SNB (20 mL). Both groups received blocks of 0.25% bupivacaine. Results: The incidence of success was significantly higher in group A compared to group B (90.77% vs. 76.92%, P = 0.032). Intraoperative heart rate (HR) and mean arterial blood pressure (at 30 and 45 min), pain scores (at 6h), and total morphine consumption within the first 24 hours were significantly lower in group A compared to group B (P < 0.05). The time to the first request for rescue analgesia was significantly prolonged in group A compared to group B (P < 0.001). Side effects were similar within the studied groups. Patient satisfaction was considerably higher in group A compared to group B (P = 0.020) Conclusions: The LS-ESPB is more effective than the PCB-SNB combination for unilateral LL surgeries, offering a higher incidence of success, more stable hemodynamics, better analgesia, and higher patient satisfaction, with similar side effects.