To compare the mean duration of postoperative analgesia between unilateral spinal anaesthesia and combined popliteal sciatic nerve block with adductor canal block in diabetic patients undergoing below-knee amputation.
Adults aged 40 to 75 years, of either gender.
Known type 2 diabetes mellitus scheduled for below-knee amputation.
ASA physical status II or III.
Documented allergy to amide local anaesthetics.
A bleeding tendency, or the use of anticoagulant or antiplatelet drugs, makes regional anaesthesia unsafe.
Skin infection at the spinal or block puncture site.
Pre-existing nerve disease of the same limb that would confuse block assessment.
Parallel
0.5 % hyperbaric Bupvicaine
DrugPatients in Group A will receive unilateral spinal anaesthesia. The anesthesiologist will inject a small dose of 0.5% hyperbaric bupivacaine through a pencil-point spinal needle, keep the limb to be operated on in the dependent position, and hold the lateral posture for about fifteen minutes so the block settles on one side. Patients in Group B will receive an ultrasound-guided popliteal sciatic nerve block together wi
15 ml of 0.5 bupvicaine
DrugGroup B will receive 15 mL of 0.5% bupivacaine for the popliteal sciatic nerve block and 10 mL of 0.25% bupivacaine for the adductor canal block (total 25 mL), keeping the total dose within 2 mg/kg
Postoperative analgesia
This will be assessed by visual analogue scale
Total analgesic consumption
Complication
Complication such as vascular puncture and Local anesthetic systemic toxicity
Hemodynamics variable
Variable such as Heart rate, Blood pressure
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