A Comparative Study of Hemodynamic Stability in Patients Having Impaired Ejection Fraction Undergoing Lower Limb Surgery in Regional Nerve Block Versus Epidural Block

Background: Heart failure (HF), a syndrome resulting from structural and functional myocardial abnormalities, is characterized by compromised ventricular filling or ejection, leading to symptoms such as dyspnea and peripheral edema. Patients with low left ventricular ejection fraction (LVEF) undergoing surgery are at increased risk for perioperative complications. Hemodynamic management in such patients, particularly with regional anesthesia techniques, is crucial to reduce intraoperative and postoperative risks. Aim & Objectives: This study aimed to compare the hemodynamic stability, pain control, and complications in patients with impaired ejection fraction undergoing lower limb surgery under regional nerve block versus epidural block. Materials & Methods: A randomized, controlled trial was conducted in the Department of Anesthesia at MLN Medical College, Prayagraj. A total of 88 patients with LVEF <45%, aged 60?92 years, were randomized into two groups: Group A (epidural block) and Group B (regional nerve block). Baseline characteristics, including age, gender, and hemodynamic parameters, were comparable between the groups. Hemodynamic variables, pain scores (VAS and Bromage scores), and incidence of complications were recorded during surgery. Results: The duration of surgery did not differ significantly between groups. Patients in Group A had significantly lower pain scores (VAS: 0.59?0.54; Bromage: 0.77?0.68) compared to Group B (VAS: 2.55?0.76; Bromage: 2.48?0.55). Hemodynamic parameters, including heart rate, systolic, and diastolic blood pressures, remained stable across both groups. However, Group A reported higher incidences of bradycardia (15.9% vs. 0.0%) and hypotension (20.5% vs. 0.0%) compared to Group B. Conversely, a significantly higher proportion of Group B patients experienced pain (38.6% vs. 0.0%). Conclusion: Both techniques provided comparable intraoperative hemodynamic stability. However, regional nerve block resulted in higher pain incidence, while epidural block was associated with increased rates of hypotension and bradycardia. Individualized anesthetic planning is essential to optimize outcomes in this patient population.