Efficacy of local anaesthetic peri-femoral artery injection compared to subcutaneous infiltration in combination with femoral and sciatic nerve blocks for reducing thigh tourniquet-induced hypertension during lower-limb surgery under general anaesthesia: A randomised controlled double-blinded trial.

BACKGROUND AND AIMS: Tourniquet-induced hypertension (TH) remains an unresolved issue. Various techniques, such as peripheral nerve blocks, peri-femoral artery blocks, and subcutaneous infiltration, have been explored to address this. The primary objective was to compare the incidence of TH during lower-limb surgery under general anaesthesia between peri-femoral artery block and subcutaneous infiltration, combined with femoral and sciatic nerve blocks. Secondary objectives included intraoperative intravenous fentanyl and antihypertensive uses, as well as postoperative pain scores.

METHODS

This single-centre, double-blind, randomised controlled trial involved 58 patients scheduled for elective lower-limb surgery. Participants were assigned to the peri-femoral artery block (P-FAB) or subcutaneous infiltration (SI) groups. All patients received general anaesthesia alongside femoral and sciatic nerve blocks. TH was defined as a 30% increase in systolic blood pressure from baseline. Pain was assessed using a numerical rating scale in the post-anaesthetic care unit and at 4, 8, 12, and 24 h post-surgery. Unpaired t-test, Chi-square, and Mann-Whitney U test were used for analysis. A P value less than 0.05 was considered to be statistically significant.

RESULTS

There were no significant differences in the incidence of TH between the P-FAB and SI groups (P = 1.00). Similarly, no significant differences were observed in intraoperative fentanyl (P = 0.459) or antihypertensive use (P = 0.992). Pain scores across all measured aspects, including thigh and incision sites, were also not significantly different between groups (P > 0.05).

CONCLUSIONS

In lower-limb surgery, adding a peri-femoral artery block to general anaesthesia with femoral and sciatic nerve blocks did not reduce the incidence of TH compared to subcutaneous infiltration.