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Yu D, Wang X, Jiang L, Wu Y, Han S, Li J. Evaluating the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta-analysis. Int Wound J 2024; 21:e14640. [PMID: 38155428 PMCID: PMC10961860 DOI: 10.1111/iwj.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023] Open
Abstract
This systematic review and meta-analysis evaluate the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed-effect and random-effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82-10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve-related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = -8.57; 95% CI: -11.27 to -5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound-guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.
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Affiliation(s)
- Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
| | - Xiaoyu Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
| | - Li Jiang
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
| | - Yajing Wu
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
| | - Shuang Han
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
| | - Jianli Li
- Department of AnesthesiologyHebei General HospitalShijiazhuangChina
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2
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White L, Bright M, Velli G, Boon M, Thang C. Efficacy and safety of proximal popliteal sciatic nerve block compared with distal sciatic bifurcation or selective tibial and peroneal nerve block: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2022; 129:e158-e162. [DOI: 10.1016/j.bja.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
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Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
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Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
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4
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Karmakar MK, Reina MA, Sivakumar RK, Areeruk P, Pakpirom J, Sala-Blanch X. Ultrasound-guided subparaneural popliteal sciatic nerve block: there is more to it than meets the eyes. Reg Anesth Pain Med 2020; 46:268-275. [PMID: 33077429 DOI: 10.1136/rapm-2020-101709] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Abstract
The popliteal sciatic nerve block is routinely used for anesthesia and analgesia during foot and ankle surgery. This article reviews our current understanding of the anatomy of the sciatic nerve and discusses how fascial tissue layers associated with the nerve may affect block outcomes . The anatomy of the sciatic nerve is more complex than previously described. The tibial and common peroneal nerves within the sciatic nerve trunk appear to be centrally separated by the Compton-Cruveilhier septum and encompassed by their own paraneural sheaths. This unique internal architecture of the sciatic nerve appears to promote proximal spread of local anesthetic to the internal aspect of the sciatic nerve trunk after a subparaneural injection at or below the divergence of the tibial and common peroneal nerves.
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Affiliation(s)
- Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China
| | - Miguel A Reina
- Department of Anesthesiology, CEU San Pablo University School of Medicine, Madrid, Spain
| | - Ranjith Kumar Sivakumar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China
| | - Pornpatra Areeruk
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China
| | - Jatuporn Pakpirom
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China
| | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
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5
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P. A year in review in Minerva Anestesiologica 2018. Minerva Anestesiol 2020; 85:206-220. [PMID: 30773000 DOI: 10.23736/s0375-9393.19.13597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital School of Medicine Campus Bio-Medico of Rome, Rome, Italy
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesiology and Intensive Care, Pitié-Salpètrière Hospital, Sorbonne University Paris, Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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6
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Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta Anaesthesiol Scand 2020; 64:238-244. [PMID: 31605392 DOI: 10.1111/aas.13489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/22/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sciatic nerve blocks are used for many orthopaedic procedures on the knee, lower leg, foot and ankle. However, as nerve block durations vary considerably, the timing of supplemental analgesia is challenging. Therefore, knowledge on the effect of local anaesthetic (LA) dose on block duration is important to outweigh the benefits of increasing LA dose against the risk of LA systemic toxicity. In this randomized, double-blind trial, we aimed to explore the relationship between the volume of ropivacaine 0.2% and sciatic nerve block duration. We hypothesized that increasing LA volume would prolong block duration. METHODS We randomized 60 healthy volunteers to receive one of five volumes of ropivacaine 0.2%: 5, 10, 15, 20, or 30 mL. We used an ultrasound-guided, catheter-based technique targeting the sciatic nerve in the infragluteal region. The primary outcome was sensory block duration defined as the time of insensitivity to a cold stimulus. Intergroup differences were tested using one-way ANOVA. RESULTS Mean (SD) sensory block durations for the tibial nerve (TN) with increasing volume were: 9.3 hours (1.7), 10.4 hours (1.6), 9.7 hours (2.9), 10.7 hours (2.8) and 9.9 hours (2.6). Mean (SD) sensory block durations for the common peroneal nerve (CPN) were: 10.6 hours (2.7), 11.9 hours (1.5), 11.0 hours (3.3), 13.2 hours (3.7), and 13.5 hours (6.1). There were no intergroup differences (P = .67 [TN]; P = .25 [CPN]). CONCLUSION We found no effect of increasing the volume of ropivacaine 0.2% from 5 to 30 mL on sensory sciatic nerve block duration.
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Affiliation(s)
- Claus B. Christiansen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Mikkel H. Madsen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Christian Rothe
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Asger M. Andreasen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Lars H. Lundstrøm
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Kai H. W. Lange
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
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7
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Ultrasound-guided regional anaesthesia in foot and ankle surgery. J Clin Orthop Trauma 2020; 11:417-421. [PMID: 32405201 PMCID: PMC7211813 DOI: 10.1016/j.jcot.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 02/06/2023] Open
Abstract
The use of regional anaesthesia in foot and ankle surgery is becoming well recognised, particularly in patients who prefer to stay awake during the procedure and for better post-operative analgesia. Its use is ideal for patients with multiple co-morbidities, in whom general anaesthesia (GA) otherwise would could be challenging. The procedures performed with landmark/anatomical guidance alone carry a relatively higher risk of complications, risk of inadvertant injection into the intarvascualr space leadinf to local anaesthetic toxicity, the majority of which complications are caused by incorrect placement of the needle. Hence, ultrasound guidance is frequently used to minimise those risks. Although various regional anaesthetic techniques for foot and ankle surgery have been described, their comprehensive review is lacking. This manuscript aims to fulfil this void. The focus will be on the peripheral methods of regional anaesthesia including the plexus and single nerve blocks. Various techniques with their benefits and potential complications will be discussed. In addition, the evidence on the efficacy of an ultrasound-guided approach as well as its cost implications will be explored. There are significant considerations in deciding whether to implement this technique in routine clinical practice and this review aims to summarise the available literature to establish the evidence base behind it.
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Turbitt LR, Mariano ER, El‐Boghdadly K. Future directions in regional anaesthesia: not just for the cognoscenti. Anaesthesia 2019; 75:293-297. [DOI: 10.1111/anae.14768] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L. R. Turbitt
- Department of Anaesthesia Belfast Health and Social Care Trust BelfastUK
| | - E. R. Mariano
- Department of Anesthesiology, Peri‐operative and Pain Medicine Stanford University School of Medicine Stanford CAUSA
| | - K. El‐Boghdadly
- Department of Anaesthesia Guy's and St Thomas’ NHS Foundation Trust London UK
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9
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Sztain JF, Finneran JJ, Monahan AM, Khatibi B, Nguyen PL, Madison SJ, Bellars RH, Gabriel RA, Ahmed SS, Schwartz AK, Kent WT, Donohue MC, Padwal JA, Ilfeld BM. Continuous Popliteal-Sciatic Blocks for Postoperative Analgesia: Traditional Proximal Catheter Insertion Superficial to the Paraneural Sheath Versus a New Distal Insertion Site Deep to the Paraneural Sheath. Anesth Analg 2019; 128:e104-e108. [PMID: 31094804 DOI: 10.1213/ane.0000000000003693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We tested the hypothesis that during a continuous popliteal-sciatic nerve block, postoperative analgesia is improved with the catheter insertion point "deep" to the paraneural sheath immediately distal to the bifurcation between the tibial and common peroneal branches, compared with the traditional approach "superficial" to the paraneural sheath proximal to the bifurcation. The needle tip location was determined to be accurately located with a fluid bolus visualized with ultrasound; however, catheters were subsequently inserted without a similar fluid injection and visualization protocol (visualized air injection was permitted and usually implemented, but not required per protocol). The average pain (0-10 scale) the morning after surgery for subjects with a catheter inserted at the proximal subparaneural location (n = 31) was a median (interquartile) of 1.5 (0.0-3.5) vs 1.5 (0.0-4.0) for subjects with a catheter inserted at the distal supraparaneural location (n = 32; P = .927). Secondary outcomes were similarly negative.
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Affiliation(s)
- Jacklynn F Sztain
- From the Department of Anesthesiology, University of California, San Diego, California
| | - John J Finneran
- From the Department of Anesthesiology, University of California, San Diego, California
- OUTCOMES RESEARCH Consortium, Cleveland, Ohio
| | - Amanda M Monahan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bahareh Khatibi
- From the Department of Anesthesiology, University of California, San Diego, California
| | - Patrick L Nguyen
- From the Department of Anesthesiology, University of California, San Diego, California
| | - Sarah J Madison
- Department of Anesthesiology, Stanford University, Stanford, California
| | - Richard H Bellars
- From the Department of Anesthesiology, University of California, San Diego, California
| | - Rodney A Gabriel
- From the Department of Anesthesiology, University of California, San Diego, California
- OUTCOMES RESEARCH Consortium, Cleveland, Ohio
| | - Sonya S Ahmed
- Department of Orthopedics, University of California, San Diego, California
| | | | - William T Kent
- Department of Orthopedics, University of California, San Diego, California
| | - Michael C Donohue
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Jennifer A Padwal
- School of Medicine, University of California, San Diego, San Diego, California
| | - Brian M Ilfeld
- From the Department of Anesthesiology, University of California, San Diego, California
- OUTCOMES RESEARCH Consortium, Cleveland, Ohio
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10
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Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2019; 44:rapm-2018-000019. [PMID: 30635506 DOI: 10.1136/rapm-2018-000019] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.
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Affiliation(s)
- De Q Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, Swedish Medical Center, Seattle, Washington, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
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11
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Faiz SHR, Imani F, Rahimzadeh P, Alebouyeh MR, Entezary SR, Shafeinia A. Which Ultrasound-Guided Sciatic Nerve Block Strategy Works Faster? Prebifurcation or Separate Tibial-Peroneal Nerve Block? A Randomized Clinical Trial. Anesth Pain Med 2017; 7:e57804. [PMID: 29637044 PMCID: PMC5881004 DOI: 10.5812/aapm.57804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 05/01/2017] [Accepted: 06/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Peripheral nerve block is an accepted method in lower limb surgeries regarding its convenience and good tolerance by the patients. Quick performance and fast sensory and motor block are highly demanded in this method. The aim of the present study was to compare 2 different methods of sciatic and tibial-peroneal nerve block in lower limb surgeries in terms of block onset. METHODS In this clinical trial, 52 candidates for elective lower limb surgery were randomly divided into 2 groups: sciatic nerve block before bifurcation (SG; n = 27) and separate tibial-peroneal nerve block (TPG; n = 25) under ultrasound plus nerve stimulator guidance. The mean duration of block performance, as well as complete sensory and motor block, was recorded and compared between the groups. RESULTS The mean duration of complete sensory block in the SG and TPG groups was 35.4 ± 4.1 and 24.9 ± 4.2 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). The mean duration of complete motor block in the SG and TPG groups was 63.3 ± 4.4 and 48.4 ± 4.6 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). No nerve injuries, paresthesia, or other possible side effects were reported in patients. CONCLUSIONS According to the present study, it seems that TPG shows a faster sensory and motor block than SG.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Associate Prof of Anesthesiology, Endometriosis and Gynecologic Disorders Research Center, Iran University of Medical Sciences, Iran
| | - Farnad Imani
- Prof of Anesthesiology, Pain Research Center, Iran University of Medical Sciences, Iran
| | - Poupak Rahimzadeh
- Associate Prof of Anesthesiology, Pain Research Center, Iran University of Medical Sciences, Iran
| | | | | | - Amineh Shafeinia
- Resident of Anesthesiology, Iran University of Medical Sciences, Iran
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12
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Lyngeraa TS, Rothe C, Steen-Hansen C, Madsen MH, Christiansen CB, Andreasen AM, Lundstrøm LH, Lange KHW. Initial placement and secondary displacement of a new suture-method catheter for sciatic nerve block in healthy volunteers: a randomised, double-blind pilot study. Anaesthesia 2017; 72:978-986. [DOI: 10.1111/anae.13933] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/07/2023]
Affiliation(s)
- T. S. Lyngeraa
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. Rothe
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. Steen-Hansen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - M. H. Madsen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. B. Christiansen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - A. M. Andreasen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - L. H. Lundstrøm
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - K. H. W. Lange
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
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13
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Geiser T, Apel J, Vicent O, Büttner J. [Sciatic nerve block "out-of-plane" distal to the bifurcation: effective and safe]. Anaesthesist 2017; 66:177-185. [PMID: 28120017 DOI: 10.1007/s00101-017-0268-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/23/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage. METHODS In this randomized, prospective trial, 56 patients per group received either a DSB distal to the bifurcation "out-of-plane" (dist.) or proximally "in-plane" (prox.) with 30 ml of Mepivacaine 1% each. Success was tested by a blinded examiner after 15 and 30 min respectively (sensory and motor block of TN and CFN: 0 = none, 2 = complete, change of skin temperature). Videos of the blocks were inspected by an independent expert retrospectively with regard to the spread of the local anesthetic (LA) and accidental intraneural injection. RESULTS Cumulative single nerve measurements and temperature changes revealed significant shorter onset and better efficacy (dist/prox: 15 min: 3.13 ± 1.86/1.82 ± 1.62; 30 min: 5.73 ± 1.92/3.21 ± 1.88; T15 min: 30.3 ± 3.48/28.0 ± 3.67, T30 min. 33.0 ± 2.46/30.6 ± 3.86; MV/SD; ANOVA; p < 0.01) combined with a higher rate of subparaneural spread in the dist. group (41/51 vs.12/53; χ2; p < 0,01). Procedure times were similar. There were no complications in either group. DISCUSSION The subparaneural spread of the LA turned out to be crucial for better results in the distal group. The steep angle using the out-of-plane approach favors needle penetration through the paraneural sheath. The distance between the branches allows the safe application of the LA, so an effective block can be done with just one injection. CONCLUSION DSB slightly distal to the bifurcation, in an out-of-plane technique between the TN and CFN, can be done fast, effectively and safe.
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Affiliation(s)
- T Geiser
- Abteilung für Anästhesiologie und Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Deutschland.
| | - J Apel
- Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, Kantonsspital St.Gallen, St. Gallen, Schweiz
| | - O Vicent
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden, Deutschland
| | - J Büttner
- Abteilung für Anästhesiologie und Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Deutschland
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14
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Monahan AM, Madison SJ, Loland VJ, Sztain JF, Bishop ML, Sandhu NS, Bellars RH, Khatibi B, Schwartz AK, Ahmed SS, Donohue MC, Nomura ST, Wen CH, Ilfeld BM. Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial. Anesth Analg 2016; 122:1689-95. [PMID: 26962712 DOI: 10.1213/ane.0000000000001211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multiple studies have demonstrated that, for single-injection popliteal sciatic nerve blocks, block characteristics are dependent upon local anesthetic injection relative to the sciatic nerve bifurcation. In contrast, this relation remains unexamined for continuous popliteal sciatic nerve blocks. We, therefore, tested the hypothesis that postoperative analgesia is improved with the perineural catheter tip at the level of the bifurcation compared with 5 cm proximal to the bifurcation. METHODS Preoperatively, subjects having moderately painful foot or ankle surgery were randomly assigned to receive an ultrasound-guided subepimyseal perineural catheter inserted either at or 5 cm proximal to the sciatic nerve bifurcation. Subjects received a single injection of mepivacaine 1.5% either via the insertion needle preoperatively or the perineural catheter postoperatively, followed by an infusion of ropivacaine 0.2% (6 mL/h basal, 4 mL bolus, and 30-min lockout) for the study duration. The primary end point was the average pain measured on a numeric rating scale (0-10) in the 3 hours before a data collection telephone call the morning after surgery. RESULTS The average numeric rating scale of subjects with a catheter inserted at the sciatic nerve bifurcation (n = 64) was a median (10th, 25th to 75th, and 90th quartiles) of 3.0 (0.0, 2.4-5.0, and 7.0) vs 2.0 (0.0, 1.0-4.0, and 5.0) for subjects with a catheter inserted proximal to the bifurcation (n = 64; P = 0.008). Similarly, maximum pain scores were greater in the group at the bifurcation: 6.0 (3.0, 4.4-8.0, and 9.0) vs 5.0 (0.0, 3.0-8.0, and 10.0) (P = 0.019). Differences between the groups for catheter insertion time, opioid rescue dose, degree of numbness in the foot/toes, catheter dislodgement, and fluid leakage did not reach statistical significance. CONCLUSIONS For continuous popliteal sciatic nerve blocks, a catheter inserted 5 cm proximal to the sciatic nerve bifurcation provides superior postoperative analgesia in subjects having moderately painful foot or ankle surgery compared with catheters located at the bifurcation. This is in marked contrast with single-injection popliteal sciatic nerve blocks for which benefits are afforded to local anesthetic injection distal, rather than proximal, to the bifurcation.
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Affiliation(s)
- Amanda M Monahan
- From the *Department of Anesthesiology, University of California San Diego, San Diego, California; †Department of Orthopedics, University of California San Diego, San Diego, California; ‡Division of Biostatistics and Bioinformatics, University of California San Diego, San Diego, California; §School of Medicine, University of California San Diego, San Diego, California; ‖Department of Ophthalmology, University of California San Diego, San Diego, California; and ¶OUTCOMES RESEARCH Consortium, Cleveland, Ohio
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Vermeylen K, De Puydt J, Engelen S, Roofthooft E, Soetens F, Neyrinck A, Van de Velde M. A double-blind randomized controlled trial comparing dexamethasone and clonidine as adjuvants to a ropivacaine sciatic popliteal block for foot surgery. Local Reg Anesth 2016; 9:17-24. [PMID: 27226733 PMCID: PMC4863693 DOI: 10.2147/lra.s96073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background and aims A popliteal block is effective in managing postoperative pain for foot surgery, but since the duration of analgesia is limited following a single-shot popliteal fossa block technique, methods to prolong effective postoperative analgesia are mandatory. The aim of this study was to assess the effect of adjuvants to ropivacaine on the duration of sensory and motor block. Methods In this double-blind randomized placebo-controlled study, we evaluated the analgesic effect of clonidine or dexamethasone (DXM) when added to ropivacaine for hallux valgus surgery. After obtaining institutional ethics research board approval and written informed consent, a total of 72 patients were randomly allocated. Fifty-seven of these patients were statistically analyzed. All patients received an ultrasound-guided single-shot popliteal fossa block with 30 mL of ropivacaine 0.75%, supplemented with saline, clonidine 100 µg, or DXM 5 mg. The primary end point was time to first pain sensation. Secondary end points were time to complete sensory and motor block regression. Results Compared to saline, duration to first pain sensation was prolonged by 9 hours (mean ± standard deviation: 31±9 hours) (42%) in the DXM group (P=0.024) and by 6 hours (28±10 hours) (27%) in the clonidine group (P=0.024). Compared to saline, DXM prolonged both complete sensory and motor blockade by 12 hours (25±7 hours) (46%) and 13 hours (36±6 hours) (55%), respectively, while clonidine prolonged complete sensory and motor blockade by 7 hours (30±7 hours) (27%) and 2 hours (22±5 hours) (10%), respectively. DXM prolonged sensory block regression time by 6 hours (21±7 hours) (41%) and clonidine by 2 hours (17±6 hours) (13%) compared to the control group (P=0.006). Similarly, DXM prolonged motor block regression by 7 hours (25±7 hours) (46%) and clonidine by 4 hours (21±4 hours) (19%) (P<0.0001). Conclusion Addition of DXM and clonidine to ropivacaine significantly prolonged the duration of postoperative sensory and motor block.
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Affiliation(s)
- Kris Vermeylen
- Department of Anesthesia and Intensive Care, AZ Turnhout, Turnhout, Belgium
| | - Joris De Puydt
- Department of Anesthesia, University Hospital Antwerp, Antwerp, Belgium
| | - Stefan Engelen
- Department of Anesthesia, ZNA Hospital Network Antwerp, Antwerp, Belgium
| | - Eva Roofthooft
- Department of Anesthesia, ZNA Hospital Network Antwerp, Antwerp, Belgium
| | - Filiep Soetens
- Department of Anesthesia and Intensive Care, AZ Turnhout, Turnhout, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences and Anesthesiology, Catholic University Hospitals, Louvain, Belgium
| | - Marc Van de Velde
- Department of Cardiovascular Sciences and Anesthesiology, Catholic University Hospitals, Louvain, Belgium
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Ultrasound-guided popliteal sciatic nerve blockade in the severely and morbidly obese: a prospective and randomized study. J Anesth 2016; 30:397-404. [DOI: 10.1007/s00540-016-2143-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/22/2016] [Indexed: 11/27/2022]
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17
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Evidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block. Reg Anesth Pain Med 2016; 41:261-74. [DOI: 10.1097/aap.0000000000000336] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Effects of the Intraneural and Subparaneural Ultrasound-Guided Popliteal Sciatic Nerve Block. Reg Anesth Pain Med 2016; 41:430-7. [DOI: 10.1097/aap.0000000000000413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeong JS, Shim JC, Jeong MA, Lee BC, Sung IH. Minimum Effective Anaesthetic Volume of 0.5% Ropivacaine for Ultrasound-Guided Popliteal Sciatic Nerve Block in Patients Undergoing Foot and Ankle Surgery: Determination of ED50 and ED95. Anaesth Intensive Care 2015; 43:92-7. [DOI: 10.1177/0310057x1504300114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Compared to nerve stimulation or classic paraesthesia techniques, ultrasound (US)-guided popliteal sciatic nerve block requires a smaller volume of local anaesthetic. The up-and-down method was used to determine the minimum effective anaesthetic volume of 0.5% ropivacaine necessary for US-guided popliteal sciatic nerve block to achieve successful surgical anaesthesia for foot and ankle surgery. The study included 32 patients receiving an US-guided popliteal sciatic nerve bock. The starting dose of 0.5% ropivacaine was set at 30 ml, which was decreased by 3 ml if the block succeeded and increased by 3 ml if the block failed. After the injection of local anaesthetic, the degree of sensory and motor blockade of the tibial and common peroneal nerves was assessed every 5 minutes for 30 minutes. The ED50 and ED95 volumes of local anaesthetic were 6 ml and 16 ml, respectively. The success rates of sensory blockade of the tibial nerve and common peroneal nerve were 69% and 88%, respectively. The success rates of motor blockade of these nerves were 75% and 90%, respectively. The ED50 and ED95 of 0.5% ropivacaine for US-guided popliteal sciatic nerve block were 6 ml and 16 ml, respectively.
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Affiliation(s)
- J. S. Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seongdong gu, Seoul, Republic of Korea
| | - J. C. Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seongdong gu, Seoul, Republic of Korea
| | - M. A. Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seongdong gu, Seoul, Republic of Korea
| | - B. C. Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seongdong gu, Seoul, Republic of Korea
| | - I. H. Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seongdong gu, Seoul, Republic of Korea
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Yamamoto H, Sakura S, Wada M, Shido A. A Prospective, Randomized Comparison Between Single- and Multiple-Injection Techniques for Ultrasound-Guided Subgluteal Sciatic Nerve Block. Anesth Analg 2014; 119:1442-8. [DOI: 10.1213/ane.0000000000000462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA.
| | - Neil A Hanson
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA
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Abstract
Peripheral nerve blocks (PNBs) provide significant improvement in postoperative analgesia and quality of recovery for ambulatory surgery. Use of continuous PNB techniques extend these benefits beyond the limited duration of single-injection PNBs. The use of ultrasound guidance has significantly improved the overall success, efficiency, and has contributed to the increased use of PNBs in the ambulatory setting. More recently, the use of ultrasound guidance has been demonstrated to decrease the risk of local anesthetic systemic toxicity. This article provides a broad overview of the indications and clinically useful aspects of the most commonly used upper and lower extremity PNBs in the ambulatory setting. Emphasis is placed on approaches that can be used for single-injection PNBs and continuous PNB techniques.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101-2756, USA.
| | - Raymond S Joseph
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101-2756, USA
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Edward Kim T, Howard SK, Funck N, Kyle Harrison T, Walters TL, Wagner MJ, Ganaway T, Mullens J, Lehnert B, Mariano ER. A randomized comparison of long-axis and short-axis imaging for in-plane ultrasound-guided popliteal-sciatic perineural catheter insertion. J Anesth 2014; 28:854-60. [DOI: 10.1007/s00540-014-1832-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/04/2014] [Indexed: 11/27/2022]
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Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery. Reg Anesth Pain Med 2014; 39:18-25. [DOI: 10.1097/aap.0000000000000030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ultrasound-guided popliteal block through a common paraneural sheath versus conventional injection: a prospective, randomized, double-blind study. Reg Anesth Pain Med 2013; 38:218-25. [PMID: 23558372 DOI: 10.1097/aap.0b013e31828db12f] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The macroscopic anatomy of a common paraneural sheath that surrounds the sciatic nerve in the popliteal fossa has been studied recently in a human cadaveric study. It has been suggested that an injection through this sheath could be an ideal location for local anesthetic administration for popliteal block. The aim of the present study was to evaluate the hypothesis that popliteal sciatic nerve blockade through a common paraneural sheath results in shorter onset time when compared with conventional postbifurcation injection external to the paraneural tissue. To illustrate the microscopic anatomy of the paraneural tissues, we performed histological examinations of a human leg specimen. METHODS Following institutional review board approval and written informed consent, 89 patients undergoing an ultrasound-guided popliteal block for foot or ankle surgery were included in the study. They were prospectively randomized to receive a single injection of local anesthetic at the site of bifurcation through a common paraneural sheath (group 1) or 2 separate circumferential injections of the tibial and common peroneal nerves distally to sciatic nerve bifurcation (group 2). RESULTS Patients in group 1 had a 30% shorter onset time of both sensory and motor block. This was associated with a more extensive proximal and distal longitudinal spread of local anesthetic in this group. Nerve diameter and cross-sectional area remained unchanged in both groups after injection, which is consistent with extraneural injection. A greater proportion of patients in group 1 required a single needle pass for block performance. DISCUSSION An ultrasound-guided popliteal sciatic nerve block through a common paraneural sheath at the site of sciatic nerve bifurcation is a simple, safe, and highly effective block technique. It results in consistently short onset time, while respecting the integrity of the epineurium and intraneural structures.
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Tran DQH, González AP, Bernucci F, Pham K, Finlayson RJ. A Randomized Comparison Between Bifurcation and Prebifurcation Subparaneural Popliteal Sciatic Nerve Blocks. Anesth Analg 2013; 116:1170-1175. [DOI: 10.1213/ane.0b013e31828a73be] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Distale Blockaden des N. ischiadicus. Anaesthesist 2013; 62:183-88, 190-2. [DOI: 10.1007/s00101-013-2150-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/18/2013] [Accepted: 01/29/2013] [Indexed: 11/25/2022]
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A Dose-Ranging Study of 0.5% Bupivacaine or Ropivacaine on the Success and Duration of the Ultrasound-Guided, Nerve-Stimulator–Assisted Sciatic Nerve Block. Reg Anesth Pain Med 2013; 38:492-502. [DOI: 10.1097/aap.0b013e3182a4bddf] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khabiri B, Hamilton C, Norton J, Arbona F. Ultrasound-guided supine posterior approach for popliteal sciatic nerve block. J Clin Anesth 2012; 24:680. [PMID: 23228876 DOI: 10.1016/j.jclinane.2012.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/20/2012] [Accepted: 04/18/2012] [Indexed: 11/25/2022]
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Sakura S, Hara K. Using ultrasound guidance in peripheral nerve blocks. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Faulí A, Anglada MT, Gomar C, Sala X, López A, Pons M, Gambús P, Fábregas N. [Comparison of 3 combinations of 0.5% levobupivacaine and 1% mepivacaine in popliteal sciatic block in hallux valgus outpatient surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:549-555. [PMID: 23040652 DOI: 10.1016/j.redar.2012.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/24/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND To compare 3 combinations of 0.5% levobupivacaine (L) and 1% mepivacaine (M) for popliteal block for hallux valgus surgery. METHODS Prospective, double blind study of 120 patients undergoing unilateral hallux valgus outpatient surgery with posterior popliteal block with ultrasound-guided single injection. Patients were randomly allocated into three groups: G1: 20mL L+10mL M; G2: 10mL L+20mL M; and G3: 15mL L+15mL M. Recorded variables were: time of block, onset and reversal times for tibial and peroneal nerves block; postoperative pain until the 7(th) day by means of visual analogue scale (VAS), simple descriptive scale and the quality of nocturnal rest, complications, and patient satisfaction. ANOVA and chi2 were applied in the statistical analysis, with a P<0.05 considered significant. RESULTS Groups were homogeneous for demographic and surgical characteristics. None of the patients required intraoperative complementary analgesia or anaesthesia. Block onset was significantly longer in G1 than in G2 and G3 (39.4±14.7 versus 32.2±16.5 and 33.2±12minutes). Recovery time from sensory and motor block was significantly longer in G1 than in G2 and G3 (29.5±9.3 versus 22.2±8.2 and 24.8±7.9hours). Postoperative pain level was below VAS 30 (1-100) in the three groups; none of the patients experienced severe pain. Maximum pain level appeared at 24h postoperatively. Patient satisfaction was high and there were no complications. CONCLUSIONS Block onset time and anaesthetic efficacy was adequate in the three groups. The combination of 20mL levobupivacaine 0.5% with 10mL mepivacaine 1% provide a good alternative for a lasting postoperative analgesia.
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Affiliation(s)
- A Faulí
- Departamento de Anestesiología, Universidad de Barcelona, Barcelona, España.
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Where should the tip of the needle be located in ultrasound-guided peripheral nerve blocks? Curr Opin Anaesthesiol 2012; 25:596-602. [DOI: 10.1097/aco.0b013e328356bb40] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aveline C. [Should we follow a specific procedure for ultrasound-guided regional anaesthesia? Evidence-basis for ultrasound-guided single-shot procedures]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:e167-e177. [PMID: 22796175 DOI: 10.1016/j.annfar.2012.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- C Aveline
- Service d'anesthésie-réanimation chirurgical, centre hospitalier privé Sévigné, 8, rue du Chêne-Germain, 35517 Cesson-Sévigné, France.
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Sinha SK, Abrams JH, Arumugam S, D'Alessio J, Freitas DG, Barnett JT, Weller RS. Femoral Nerve Block With Selective Tibial Nerve Block Provides Effective Analgesia Without Foot Drop After Total Knee Arthroplasty. Anesth Analg 2012; 115:202-6. [DOI: 10.1213/ane.0b013e3182536193] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sala-Blanch X, de Riva N, Carrera A, López AM, Prats A, Hadzic A. Ultrasound-Guided Popliteal Sciatic Block with a Single Injection at the Sciatic Division Results in Faster Block Onset than the Classical Nerve Stimulator Technique. Anesth Analg 2012; 114:1121-7. [DOI: 10.1213/ane.0b013e318248e1b3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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A 3-Dimensional Ultrasound Study of Local Anesthetic Spread During Lateral Popliteal Nerve Block. Reg Anesth Pain Med 2012; 37:627-32. [DOI: 10.1097/aap.0b013e31826af511] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Sean Flack
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA.
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Germain G, Lévesque S, Dion N, Nadeau MJ, Coté D, Nicole PC, Turgeon AF. A Comparison of an Injection Cephalad or Caudad to the Division of the Sciatic Nerve for Ultrasound-Guided Popliteal Block. Anesth Analg 2012; 114:233-5. [DOI: 10.1213/ane.0b013e3182373887] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Reply to Drs. Ip and Tsui. Reg Anesth Pain Med 2011. [DOI: 10.1097/aap.0b013e31822b8ab8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Randomized Comparison Between Subepineural and Conventional Ultrasound-Guided Popliteal Sciatic Nerve Block. Reg Anesth Pain Med 2011; 36:548-52. [DOI: 10.1097/aap.0b013e318235f566] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tibial and common fibular nerve block in the popliteal fossa with single puncture using percutaneous nerve stimulator: anatomical considerations and ultrasound description. Rev Bras Anestesiol 2011; 61:533-43, 293-8. [PMID: 21920203 DOI: 10.1016/s0034-7094(11)70064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 02/21/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Techniques of peripheral nerve block have gained popularity over the last two decades becoming a growing anesthetic option for limb surgeries. This study proposes a technical approach of the tibial and common fibular nerves in the popliteal fossa with single puncture using percutaneous nerve stimulator, considering the correlation with an anatomical and ultrasound study. METHODS This prospective, observational, randomized study was performed with 28 patients scheduled for foot surgeries. After localizing the tibial and common fibular nerves through percutaneous stimulation, the puncture was performed at the point of tibial nerve stimulation with a 5-cm needle (B.Braun, Stimuplex 50), and 10 mL of levobupivacaine were injected. The needle was pulled back and redirected to the point of common fibular nerve stimulation looking for the corresponding motor response, and 10 mL of the local anesthetic were injected. Imaging study of the popliteal region was performed by ultrasound to correlate the anatomy with the technique used. RESULTS Adequate anesthesia was obtained in all cases. The mean time to localize the tibial and common fibular nerves suing the percutaneous stimulator was 57.1 and 32.8 seconds, respectively, and with the nerve stimulator it was 2.22 and 1.79 minutes, respectively. The mean depth of the needle into the tibial nerve was 10.7 mm. CONCLUSIONS The approach for tibial and common fibular nerves with single puncture in the popliteal fossa using peripheral nerve stimulator is a good option for anesthesia and analgesia for foot surgeries.
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Current world literature. Curr Opin Anaesthesiol 2011; 24:592-8. [PMID: 21900764 DOI: 10.1097/aco.0b013e32834be5b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Reply to Dr. van Zundert. Reg Anesth Pain Med 2010. [DOI: 10.1097/aap.0b013e3181fa11ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ultrasound-Guided Popliteal Block Shortens Onset Time Compared to Prebifurcation Sciatic Block. Reg Anesth Pain Med 2010; 35:565-6; author reply 566. [DOI: 10.1097/aap.0b013e3181fa11bb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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