Comparison of Time Development of the Sciatic Nerve Blockade Performed with 1% Lidocaine Subgluteal and Popliteal Approach under Ultrasound Guidance

Piacherski Valery,Zakhar Kokhan,Marachkou Aliaksei,Brukhnou Andrei

doi:10.4236/ojanes.2014.412046

Abstract

The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in comparison with subgluteal sciatic nerve blockade. Background: The aim of the research is to compare the time of the development of the sciatic nerve blockade performed with 1% lidocaine with epinephrine (1:200,000) in subgluteal and popliteal areas under ultrasound guidance. Materials and Methods: Patients were divided into two groups. In Group A (20 patients), the subgluteal approach to block the sciatic nerve was taken; in Group B (20 patients), the popliteal approach was applied. All blockades of the sciatic nerve were performed with 1% lidocaine (30 ml of lidocaine with epinephrine (1:200,000)) and electrical stimulation of peripheral nerves under ultrasound guidance. We measured the time of the development of sensory and motor blocks. Results: In Group A, the sciatic nerve sensory block developed in 15 (14 - 16) minutes, a complete motor block developed in 15.5 (15 - 17) minutes. In Group B the sciatic nerve sensory block developed in 40 (38.5 - 42.5) minutes while a complete motor block did not develop in any patient. Conclusion: When the sciatic nerve is blocked in subgluteal area with 30 ml of 1% lidocaine with epinephrine (1:200,000) under ultrasound guidance, sensory blocks develop faster than during the popliteal blockade: 15 (14 - 16) minutes vs. 40 (38.5 - 42.5) minutes respectively. The opportunity to define the place of the introduction of local anesthetic in our research is limited.

Highlights

It was expected that the use of ultrasound guidance in performing peripheral blockades could raise their efficiency to 100% [1]
The purpose of this study is to compare the time of peripheral blockade of the sciatic nerve with 1% lidocaine with epinephrine (1:200,000) carried out in subgluteal or popliteal areas under ultrasound guidance
To estimate the rate of anesthesia development according to the approach we grouped the patients: in Group A (20 patients) the sciatic nerve blockade was performed in subgluteal area with the introduction of 30 ml of 1% lidocaine with epinephrine (1:200,000); in Group B (20 patients) the popliteal approach (30 ml of 1% lidocaine with epinephrine (1:200,000)) was implemented

Summary

Introduction

It was expected that the use of ultrasound guidance in performing peripheral blockades could raise their efficiency to 100% [1]. Different authors are reporting varying data on the effectiveness of regional blocks performed under ultrasound guidance: performance indicators vary from 80% [1] to 100% [2] [3]. Moayeri et al has demonstrated that in the proximal parts of the sciatic nerve, the ratio of non-neural and neural tissue is 2:1, whereas in the popliteal fossa, the ratio is 1:1 [4]. The observed values may explain the differences seen in MEAV (minimum effective anesthetic volume) and in onset time at different levels of the sciatic nerve [4]. Moayeri et al their assumptions need clinical confirmation [4]

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