• G Fanelli, A Casati, G Aldegheri, P Beccaria, M Berti, A Leoni, and G Torri.
• Department of Anaesthesiology and Intensive Care, IRCCS H San Raffaele, University of Milan, Italy.
• Acta Anaesthesiol Scand. 1998 Jan 1;42(1):80-4.

BackgroundCardiovascular function was assessed in 20 ASA I-II patients, scheduled for elective orthopaedic surgery with tourniquet in order to compare the haemodynamic changes induced by unilateral spinal anaesthesia and combined sciatico-femoral nerve block.MethodsAfter baseline measurement of cardiovascular parameters, patients were randomized to receive unilateral spinal anaesthesia or combined sciatico-femoral nerve block. Spinal anaesthesia was obtained by 8 mg of hyperbaric bupivacaine 0.5% slowly injected (speed=0.02 ml s[-1]) through a 25-G Whitacre spinal needle with the bevel orientated towards the dependent side and patients lying on their operated side for 15 min (group S, n=10). Combined sciatico-femoral nerve block was obtained by 7 mg kg(-1) of mepivacaine 2% (group NB, n=10). Haemodynamic variables were recorded 5, 10, 15, and 30 min after anaesthetic injection before surgery was started.ResultsAnthropometric data, duration of surgery and acceptability of anaesthetic techniques were similar in the 2 groups. In 8 patients of group S, spinal block was restricted to the operated side (pinprick test and Bromage scale), while the other 2 patients developed bilateral spinal block after being turned supine. NB patients showed no haemodynamic changes during the study, whereas patients in group S showed a small but significant decrease of mean arterial blood pressure (P<0.002 vs baseline and P<0.04 vs NB), cardiac index (P<0.01 vs baseline and P<0.01 vs NB), and stroke volume index (P<0.01 vs baseline and P<0.01 vs NB).ConclusionBoth sciatico-femoral and unilateral spinal blockade provide adequate anaesthesia for unilateral leg surgery with tourniquet. The former technique affects cardiovascular performance less than the latter one.

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