Comparative Study of Cardiovascular Morbidity with Ultrasound -Guided Combined Sciatic-Femoral Block and Unilateral Spinal Anaesthesia in High - Risk Patients Posted For Lower Limb Surgeries

Q: What are the key findings of this study?

Ultrasound-guided combined sciatic-femoral block had a lower incidence of hypotension than unilateral spinal anaesthesia in high-risk lower limb surgery patients.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: High-risk patients (ASA III and IV) undergoing lower limb surgeries (n=79). Intervention: Ultrasound-guided combined sciatic-femoral block (US CSFB) vs. Unilateral spinal anaesthesia (USA). Primary outcome: Incidence of intraoperative hypotension (defined as SBP <20% of preoperative level or <90 mmHg) (p=<0.001).

Q: What does this research mean for the field?

Ultrasound-guided combined sciatic-femoral block provides superior hemodynamic stability and significantly lower rates of hypotension compared to unilateral spinal anesthesia in high-risk patients undergoing lower limb surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare cardiovascular morbidity and hemodynamic stability between ultrasound-guided combined sciatic-femoral block and unilateral spinal anaesthesia in high-risk patients undergoing lower limb surgeries.

Aleena Sebastian; Deepali Thakur; Rosu Mary John

doi:10.25258/ijcpr.18.7.71

July 30, 2026International Journal of Current Pharmaceutical Review and ResearchOpen Access

Comparative Study of Cardiovascular Morbidity with Ultrasound -Guided Combined Sciatic-Femoral Block and Unilateral Spinal Anaesthesia in High - Risk Patients Posted For Lower Limb Surgeries

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Key result

Combined sciatic-femoral block linked to ~48 percentage points less hypotension than spinal anesthesia.

P<0.001
n=79

Why the study?

Ultrasound-guided combined sciatic femoral block is an alternative to unilateral spinal anaesthesia for lower limb surgeries, prompting a comparison of their cardiovascular morbidity in high-risk patients.

Does ultrasound-guided combined sciatic-femoral block reduce intraoperative hypotension and cardiovascular morbidity compared to unilateral spinal anaesthesia in high-risk ASA III and IV patients undergoing lower limb surgeries?

Key Points

To compare cardiovascular morbidity and hemodynamic stability between ultrasound-guided combined sciatic-femoral block and unilateral spinal anaesthesia in high-risk patients undergoing lower limb surgeries.
Prospective observational study conducted from 2020 to 2021 enrolling 80 American Society of Anaesthesiologists (ASA) class III and IV patients aged 18 to 90 years undergoing lower limb surgery.
Patients received either unilateral spinal anaesthesia (USA; n=40, with 1 excluded for inadequate block, leaving n=39) using 6 mg of 0.5% hyperbaric bupivacaine, or ultrasound-guided combined sciatic-femoral block (CSFB; n=40) using 0.25% bupivacaine and 1% lignocaine with adrenaline.
Heart rate, systolic blood pressure (SBP), mean arterial pressure, oxygen saturation, electrocardiogram changes, and vasopressor and intravenous fluid requirements were monitored intraoperatively.
Hypotension occurred in 51% (20 of 39) of the USA group compared to 2.5% (1 of 40) of the CSFB group (P <0.001).

Study Design

Type

Observational (n=79)

Multicenter

No

Structured PICO

Does ultrasound-guided combined sciatic-femoral block reduce intraoperative hypotension and cardiovascular morbidity compared to unilateral spinal anaesthesia in high-risk ASA III and IV patients undergoing lower limb surgeries?

P

Population

79 high-risk (ASA III and IV) adults aged 18 to 90 years with multiple comorbidities undergoing lower limb surgeries, monitored intraoperatively.

E

Exposure

Ultrasound-guided combined sciatic-femoral nerve block (US CSFB) using a mixture of 0.25% bupivacaine and 1% lignocaine with adrenaline (1:200,000), 15 ml for the femoral nerve and 25 ml for the sciatic nerve.

C

Comparator

Unilateral spinal anaesthesia (USA) administered as a subarachnoid block in the lateral position with 1.2 ml (6 mg) of 0.5% hyperbaric bupivacaine in the L3-L4 space using a 25-gauge Quincke needle, keeping patients in the lateral position for 10 minutes following the block. Both groups received 2 ml/kg/hour of balanced salt solution during fasting and oxygen 2 L/min through nasal prongs.

O

Outcome

Intraoperative cardiovascular morbidity and hemodynamic stability, specifically incidence of hypotension (defined as systolic blood pressure <20% of preoperative baseline level) and changes in systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate monitored up to 120 minutes.safety

Main Result

Absolute Event Rate: 2.5% vs 51%

p-value: p=<0.001

Limitations

Group allocation was decided by the attending anaesthesiologist based on patient characteristics and surgery, which may introduce selection bias
Observational study design requiring validation in future randomized controlled trials
Baseline ASA classification differed significantly between groups, with the CSFB group having more ASA IV patients
Observational study design without randomization
Significant baseline difference in ASA classification between groups (more ASA IV patients in the CSFB group)

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Implication

In high-risk ASA III and IV patients undergoing lower limb surgery, ultrasound-guided combined sciatic-femoral block provides markedly superior intraoperative hemodynamic stability with significantly lower rates of hypotension and vasopressor use compared to unilateral spinal anaesthesia.

Abstract

Background & Aims: Unilateral spinal anaesthesia (USA) is known for its cardiovascular stability and used in high-risk patients for its safety profile. Ultrasound-guided combined sciatic femoral block (US CSFB) is an alternative to USA for lower limb surgeries. This prospective observational study, we compared cardiovascular morbidity of US CSFB and USA in high-risk patients undergoing lower limb surgeries. Methods: After institutional ethics committee approval 80 ASA III, IV patients were enrolled. 40 in USA and 40 in CSFB group and heart rate, blood pressure, changes in SpO2 and electrocardiography, requirement of vasopressors, fluid management were monitored. Results: Hypotension incidence was 51% in USA group and 2.5% with CSFB group (P <0.001). USA group showed maximum percentage fall from baseline SBP at 20th minute (-14.78% with P 0.001) and CSFB group showed no significant fall and better hemodynamic stability. Conclusion: US CSFB provides better hemodynamic stability compared to USA in high risk patients undergoing lower limb surgeries.

Discussion

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Cite This Study

Sebastian et al. (2026) conducted an observational in High-risk patients (ASA III and IV) undergoing lower limb surgeries (n=79). Ultrasound-guided combined sciatic-femoral block (US CSFB) vs. Unilateral spinal anaesthesia (USA) was evaluated on Incidence of intraoperative hypotension (defined as SBP <20% of preoperative level or <90 mmHg) (p=<0.001). Ultrasound-guided combined sciatic-femoral block had a lower incidence of hypotension than unilateral spinal anaesthesia in high-risk lower limb surgery patients.

synapsesocial.com/papers/6af5cd26a40bbe8669e89be0 https://doi.org/10.25258/ijcpr.18.7.71

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Comparative Study of Cardiovascular Morbidity with Ultrasound -Guided Combined Sciatic-Femoral Block and Unilateral Spinal Anaesthesia in High - Risk Patients Posted For Lower Limb Surgeries

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative Study of Cardiovascular Morbidity with Ultrasound -Guided Combined Sciatic-Femoral Block and Unilateral Spinal Anaesthesia in High - Risk Patients Posted For Lower Limb Surgeries

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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