Continuous Sciatic Nerve Block Research Articles

Effects of the addition of dexamethasone on postoperative analgesia after anterior cruciate ligament reconstruction surgery under quadruple nerve blocks

BackgroundAnterior cruciate ligament (ACL) reconstruction is an invasive surgical procedure for the knee. Quadruple nerve blocks including continuous femoral nerve block and single-injection sciatic, obturator, and lateral femoral cutaneous nerve blocks can provide effective intraoperative anesthesia and analgesia in the early postoperative period. However, severe pain often appears after the effect of single-injection nerve blocks resolves and that is why we conducted two studies. The first study was to determine whether dexamethasone administered along with local anesthetic for sciatic nerve block could prolong the duration of analgesia in patients given quadruple nerve blocks, including continuous femoral nerve block, for ACL reconstruction using a hamstring tendon autograft. The second study was designed to evaluate any difference in effects from dexamethasone administered perineurally versus intravenously.MethodsPatients undergoing unilateral arthroscopic ACL reconstruction using a hamstring tendon autograft were enrolled into two studies. The first study was prospectively conducted to see if dexamethasone 4 mg could prolong the duration of analgesia when administered perineurally to the subgluteal sciatic nerve with 0.5% ropivacaine. In the second study, we retrospectively evaluated the effects of intravenous dexamethasone 4 mg as compared with those of perineural dexamethasone to the sciatic nerve block and effects with no dexamethasone.ResultsIn the first study, perineural dexamethasone prolonged the duration of analgesia by 9.5 h (median duration: 22.5 and 13.0 h with and without perineural dexamethasone, respectively, P = 0.011). In the second study, the duration of analgesia was similarly prolonged for intravenous and perineural dexamethasone compared with no dexamethasone.ConclusionPerineural dexamethasone administered along with local anesthetic for single sciatic nerve block prolonged the duration of analgesia of quadruple nerve blocks for ACL reconstruction, however the effects were not different from those of intravenous dexamethasone.Trial registrationThe protocols of both studies were approved by the Institutional Review Board of Shimane University Hospital, Japan (study number 2821 and 3390 for study 1 and study 2, respectively). Study 1 was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000028930). Study 2, which was a retrospective study, was not registered.

Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial

PurposeContinuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery.Patients and MethodsPatients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded.ResultsSixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B).ConclusionProgrammed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.

Continuous peripheral nerve block for in-patients with lower limb ischemic pain

OBJECTIVES:Demonstrate that continuous peripheral nerve block (CPNB) may be an alternative with adequate analgesia and a lower incidence of side effects for ischemic pain due peripheral obstructive arterial disease (POAD).METHODS:Retrospective cohort study with 21 patients with POAD, Fontaine IV graded, with foot pain. Patients were submitted to continuous sciatic nerve block (CSNB), through a perineural catheter. Primary outcomes were pain intensity (by numerical rating scale) and opioid consumption (in oral morphine equivalents).RESULTS:During CSNB, pain scores markedly decreased in comparison to the pre-block period.CONCLUSIONS:CPNB may be a good option for ischemic pain treatment in in-patients, as it provides effective pain control with fewer adverse effects.

Регионарные методы обезболивания у детей с ДЦП при операциях на тазобедренном суставе

Patients with cerebral palsy (CP) experience pain through the lifespan. The hip joint is the main source of nociceptive input. Use of nonopioid adjuvant medication and regional anesthesia for hip surgeries can be an integral part of a perioperative strategy to decrease opioid use. Regional anesthesia can be delivered efficiently and safely for pediatric orthopedic patients. Objective To compare different regional anesthetic techniques used for multi-level lower limb orthopedic surgeries in children with moderate and severe CP. Material and methods A prospective randomized comparative clinical trial enrolled 101 CP patients who underwent unilateral multi-level lower limb surgery for spastic hip displacement or subluxation. According to a type of anesthesia used, patients were allocated into 3 groups: patients receiving prolonged epidural analgesia (PEA) and fentanyl for sedation (PEAF, n = 32); patients receiving PEA and benzodiazepine for sedation (PEAB, n = 37), and patients receiving a continuous femoral plus single-shot sciatic nerve block and benzodiazepines for sedation (FSNBB, n = 32). Hemodynamic findings, pain intensity, a need for opioids and additives (NSAIDs), the level of sedation and complication rate were evaluated. Results The use of NSAIDs (paracetamol) was significantly higher in PEAB and FSNBB groups as compared to PEAF patients with fentanyl administered, and there were no statistically significant differences in the level of pain recorded with the r-FLACC score among the study groups. There were no statistically significant differences in the level of sedation and agitation measured with the Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS) among the groups at early postoperative period. Apnoea as a complication was observed in a PEAF patient. Conclusion A continuous femoral plus single-shot sciatic nerve block and PEA added with NSAIDs (paracetamol) and benzodiazepines for sedation have shown the comparative effectiveness and safety for a perioperative analgesia of CP patients undergoing multi-level lower limb surgeries as compared to the use of PEA and fentanyl for sedation.

The use of lumbar plexus block with Shamrock technique and continuous sciatic nerve block for thigh amputation in high risk patients.

The use of lumbar plexus block with Shamrock technique and continuous sciatic nerve block for thigh amputation in high risk patients.

Slightly better pain relief but more frequently motor blockade with combined nerve block analgesia compared to continuous intraarticular analgesia after total knee arthroplasty

PurposePain management after total knee arthroplasty (TKA) is still under debate. Continuous peripheral nerve blocks (PNB) can provide long pain relief but impair muscle function. Continuous intraarticular analgesia could result in longer pain relief than local infiltration analgesia without negative effects on muscle function. This study investigated the efficacy of pain control between PNB’s and continuous intraarticular analgesia after TKA.MethodsA prospective randomized study on 140 patients undergoing TKA was performed. Patients received either a combination of continuous femoral nerve block, continuous sciatic nerve block and single-shot obturator nerve block (group R) or a local infiltration analgesia and a continuous intraarticular catheter with ropivacaine (group L). Primary outcome was pain measured on a numerical rating scale. Knee function, patient-reported outcome (PRO) and adverse events were assessed until 1 year after surgery.ResultsPain at rest was lower in group R on the day of surgery (mean NRS 3.0 vs. 4.2) and the morning of postoperative day 1 (mean NRS 3.4 vs. 4.4). Motor blockade longer than postoperative day 3 occurred more often in group R compared to group L (15.3% vs. 1.5%). Pain levels, PRO and satisfaction 3-month and 1-year after surgery were similar.ConclusionContinuous PNB’s were slightly more effective in the first 24 h after surgery but were associated more often with motor blockade which should be avoided. It must be balanced if the small amount of better pain relief immediately after surgery justifies the risks associated with motor blockade following PNB’s.Level of evidenceI.

Factors Associated With Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks.

The objectives of this study were to investigate the correlations between the minimum effective volume (MEV) of lidocaine 1.5% for an ultrasound-guided popliteal sciatic nerve block and individual factors including the cross-sectional nerve area, sex, age, body mass index, and the depth of the sciatic nerve and to evaluate the safety of combined femoral and sciatic nerve blocks by monitoring the plasma concentration of local anesthetics. Forty patients received combined single-shot femoral and continuous sciatic nerve blocks. The femoral nerve block was performed with an in-plane technique and 15 mL of lidocaine 1.5%. A continuous peripheral nerve block annular tube was positioned between the tibial and peroneal nerves inside the paraneural sheath. Thirty minutes after the femoral nerve block, a loading dose of 5 mL of lidocaine 1.5% was given to block the sciatic nerve after obtaining the maximum compound muscle action potential (CMAP) amplitude using nerve conduction studies. Additional lidocaine 1.5% was pumped at a rate of 30 mL/h through the indwelling annular tube if, after 8 minutes, the CMAP amplitude was still present. The CMAP amplitude monitored by the nerve conduction studies and pinprick tests were recorded every 2 minutes after the administration of lidocaine 1.5%. When the CMAP amplitude decreased to nearly 0 mV, this MEV was recorded. The influences of the cross-sectional area of the sciatic nerve, sex, age, body mass index, and the depth of the sciatic nerve on the MEV were analyzed using stepwise multiple linear regression. Blood samples were collected from 10 patients to evaluate the safety of combined femoral and sciatic nerve blocks by ultra-performance liquid chromatography-tandem mass spectrometry. Blood was drawn at 0 minutes before femoral nerve injection; 0 minutes before sciatic nerve injection; 8 minutes after sciatic nerve injection; and 0, 10, 20, 30, 45, 60, 75, 90, and 120 minutes after the pumping of lidocaine 1.5% stopped. A significant correlation was found between the MEV of lidocaine 1.5% and the cross-sectional area of the sciatic nerve (r=0.459), with a regression equation of the MEV (mL)=5.969+0.095×(the cross-sectional area of the sciatic nerve). The coefficient of determination was 0.211 (P<0.05). The MEV of lidocaine 1.5% for complete sciatic nerve blocks ranged from 7 to 15 mL. The maximum concentrations of lidocaine, monoethylglycinexylidide, and glycinexylidide were 1672.9 (227.6), 265.7 (32.7), and 42.2 (22.4) ng/mL, respectively. There is a positive correlation between the cross-sectional area of the sciatic nerve and the MEV. The regression equation can help to predict the MEV of lidocaine 1.5% for popliteal sciatic nerve blocks. The maximum concentrations of lidocaine and its metabolites did not approach toxic threshold limits in this study.

Efficacy of Continuous Sciatic Nerve Block in Diabetic Foot Patients

Efficacy of Continuous Sciatic Nerve Block in Diabetic Foot Patients

Ultrasound Guided Continuous Sciatic Nerve Block for Acute Herpetic Neuralgia

Herpes Zoster (HZ) is the reactivation of a well-known viral disease which manifests itself with painful skin lesions. An effective analgesic method during the acute phase of HZ can contribute to decrease the incidence of postherpetic neuralgia (PHN) by reducing neural sensitization. Sciatic nerve block (SNB) is useful in the management of distal lower extremity pain sustained by the sciatic nerve. We describe our experience with a continuous ultrasound guided subgluteus sciatic nerve block in a patient with herpetic neuralgia- (HN-) related refractory acute left leg pain.

Continuous Sciatic Nerve Block with 0.1% Bupivacaine and the Early Detection of Compartment Syndrome in a Pediatric Patient: a Case Report

Continuous Sciatic Nerve Block with 0.1% Bupivacaine and the Early Detection of Compartment Syndrome in a Pediatric Patient: a Case Report

Efficacy of lateral femoral approach to continuous sciatic nerve block for patient-controlled analgesia after foot and ankle surgery

Objective To evaluate the efficacy of lateral femoral approach to continuous sciatic nerve block for patient-controlled analgesia after foot and ankle surgery. Methods One hundred American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 18-60 yr, weighing 50-100 kg, with body height of 145-190 cm, scheduled for elective foot and ankle surgery, were divided into 2 groups (n=50 each) using a random number table: patient-controlled nerve block analgesia (PCNA) group and patient-controlled intravenous analgesia (PCIA) group.In group PCNA, the lateral femoral approach to sciatic nerve block was performed under the guidance of ultrasound and a neurostimulator, 0.2% ropivacaine 20 ml was injected after successful location, the catheter was inserted, and 0.2% ropivacaine 10 ml was injected again.In group PCIA, 0.2% ropivacaine 30 ml was injected after successful location of the sciatic nerve.General anesthesia was performed using laryngeal mask airway in both groups.In group PCNA, PCNA was performed with 0.2% ropivacaine (diluted to 200 ml in normal saline) at the end of surgery, and the PCNA pump was set up with a 0.5 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 5 ml/h.In group PCIA, PCIA was performed with sufentanil 100 μg, tramadol 500 mg and tropisetron 10 mg (diluted to 200 ml in normal saline) at the end of surgery, and the PCIA pump was set up with a 0.5 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 2 ml/h.The visual analog scale score was maintained≤3, and postoperative analgesia lasted until postoperative 72 h. When visual analog scale scores ≥ 4, tramadol 100 mg was intramuscularly injected as rescue analgesic.The requirement for rescue analgesia and development of adverse effects such as nausea and vomiting, insomnia, puncture site infection and bleeding were recorded within 72 h after surgery. Results The requirement for rescue analgesia and incidence of nausea and vomiting were significantly lower in group PCNA than in group PCIA (P<0.05). Conclusion The lateral femoral approach to continuous sciatic nerve block can be safely and effectively used for patient-controlled analgesia after foot and ankle surgery. Key words: Nerve block; Sciatic nerve; Analgesia, patient-controlled

Comparative evaluation of the visibility and block characteristics of a stimulating needle and catheter vs an echogenic needle and catheter for sciatic nerve block with a low-frequency ultrasound probe

Background.Clear visibility of the needle and catheter tip is desirable to perform safe and successful ultrasound-guided peripheral nerve blocks. This can be challenging with deeper blocks in obese patients. This study compared the visibility of echogenic and non-echogenic block needles and catheters in proximal sciatic blocks when performed with a low-frequency curved probe. Methods.Seventy-eight patients undergoing total knee joint arthroplasty were randomized to receive an ultrasound-guided continuous sciatic nerve block using either a non-echogenic needle and stimulating catheter or an echogenic needle and echogenic non-stimulating catheter. Block needles in both groups were placed using both neurostimulation and ultrasound guidance, after which the catheter was positioned using either neurostimulation alone (Stimulating group) or imaging alone (Echogenic group). Three anaesthetists blinded to group allocation graded video clips recorded during the blocks for nerve, needle and catheter visibility. Performance characteristics and block parameters were also compared. Results.No significant differences between the two groups were observed with regard to needle or catheter visibility (P=0.516). The Stimulating group required more needle redirections (P=0.009), had a longer procedure time [Echogenic median 274 s vs Stimulating 344 s (P=0.016)], and resulted in greater patient discomfort (P=0.012). There were no significant differences between the two groups in terms of block onset or completion time. Conclusions.Use of echogenic needles and catheters reduced procedure time and patient discomfort compared with a stimulating catheter system. There were no differences in the visibility scores of the two systems. Clinical trial registristration.CTR Protocol ID: R-11-495, Clinical Trials.Gov ID: NCT 01492660.

Combined saphenous and sciatic catheters for analgesia after major ankle surgery: a double-blinded randomized controlled trial.

Continuous sciatic nerve block is used for pain management following major ankle surgery. Pain from the saphenous nerve territory often persists. We conducted a double-blinded randomized placebo-controlled trial to evaluate the effect of a supplementary saphenous catheter in the proximal thigh combined with a popliteal sciatic catheter and single-shot saphenous nerve block after major ankle surgery. Fifty patients received both sciatic and saphenous continuous catheters inserted along the short axis of the nerves with ultrasound-guidance. All patients had an initial sciatic nerve block followed by a continuous sciatic catheter infusion and an initial saphenous nerve block with ropivacaine. Participants were then randomized to infusion of either ropivacaine or isotonic saline in the saphenous catheter for 48 hr postoperatively. The primary outcome was total intravenous morphine consumption during the first 48 hr postoperatively. Secondary outcomes were clinical analgesia, saphenous analgesia, territory of worst pain, and patient satisfaction. Forty-four patients were included in the analysis. The mean (SD) 48-hr morphine consumption was 24.7 (21.6) mg in the intervention group and 27.8 (20.1) mg in the placebo group (P=0.63). The mean difference in 48-hr morphine consumption was 3.0mg (95% confidence interval, -9.7 to 15.7). There were no differences regarding the secondary outcomes. A saphenous catheter with a low-dose continuous infusion of ropivacaine, as an adjunct to a sciatic catheter, had no effect on the postoperative analgesia after major ankle surgery when both catheters were inserted along the short axis of the nerves. This trial was registered at ClinicalTrials.gov (NCT01445210).

Safety and effectiveness of bilateral continuous sciatic nerve block for bilateral orthopaedic foot surgery

Severe postoperative pain is a major problem after unilateral and bilateral foot surgery. Continuous regional anaesthesia is often used for unilateral surgery. However, for bilateral surgery, the incidence of complications of continuous bilateral compared with unilateral regional anaesthesia is unknown. To assess the incidence of catheter-related complications of bilateral compared with unilateral continuous regional anaesthesia. A prospective observational study. Bellinzona Regional Hospital, a tertiary teaching hospital. Patients (n = 130) scheduled for elective bilateral or unilateral hallux valgus repair treated with continuous popliteal sciatic nerve block using a continuous infusion of ropivacaine 0.15% at 5 ml h for each popliteal catheter by elastomeric pumps. The incidence of catheter-related complications, effectiveness, pain levels at rest and with motion, patient satisfaction for the first three postoperative days and the incidence of ambulatory visits or readmissions after discharge were measured. A follow-up for neurological or other complications related to regional anaesthesia was performed 6 to 8 weeks after surgery. The incidence of catheter-related complications comparing bilateral with unilateral continuous sciatic popliteal nerve block. There were no differences in the incidence of catheter-related complications between the groups. Pain scores at rest and with motion were comparable between the groups. All patients were fit for discharge home 3 days after surgery. Patient satisfaction was similar between the groups. There were no unplanned ambulatory visits or readmissions due to complications in either group. No complications related to regional anaesthesia were reported during the follow-up. The complication rate, effectiveness and patient satisfaction of bilateral continuous popliteal sciatic nerve block was comparable with unilateral continuous sciatic popliteal nerve block. The follow-up showed that bilateral continuous sciatic popliteal nerve block does not increase the complication rate. However, an outpatient-based study should confirm these data prior to introduction in the ambulatory setting.

Continuous Versus Single-Injection Sciatic Nerve Block Added to Continuous Femoral Nerve Block for Analgesia After Total Knee Arthroplasty

The benefit of adding sciatic nerve block (SNB) to femoral nerve block to improve analgesia after total knee arthroplasty (TKA) is uncertain. We hypothesized that the effective duration of single-injection SNB is too short to improve postoperative analgesia and that this contributes to conflicting results on the efficacy of SNB after TKA. We evaluated this hypothesis in a prospective double-blind randomized controlled trial. Sixty patients undergoing TKA were randomly allocated to a continuous SNB group or a single-injection SNB group. All patients received femoral nerve block (0.5% ropivacaine 20 mL) and SNB (0.2% ropivacaine 20 mL) and catheters were inserted into both peripheral nerve block sites before surgery. Both groups received continuous femoral nerve block and patient-controlled intravenous analgesia with morphine. Continuous SNB (0.2% ropivacaine 5 mL/h; continuous SNB group) or sham continuous SNB (0.9% normal saline 5 mL/h; single-injection SNB group) was provided after surgery. The primary outcome was total morphine consumption for 48 hours after surgery. Total morphine consumption in the 48-hour period after surgery was significantly lower in the continuous SNB group compared with the single-injection SNB group [4.9 (5.9) vs 9.7 (9.5) mg, P = 0.002]. Visual analog scale pain scores at rest were also significantly lower in the continuous SNB group (P = 0.035). The combination of continuous femoral and SNB provides a superior opioid sparing effect and improves analgesia after TKA.

Continuous Anterior Sciatic Nerve Block: A Case Series

Continuous Anterior Sciatic Nerve Block: A Case Series Sciatic nerve block is classically performed through posterior or lateral approaches. With the increased use of ultrasound, the anterior approach has gained popularity. An anterior approach should be considered in patients after trauma and severe postoperative pain where patient positioning can be challenging. The anatomical landmark techniques can be difficult for anterior approach and cannot always be relied on due to inconsistency in extremely obese population. The presence of large blood vessels in the needle path and increasing use of anticoagulants, call for the use of ultrasound guidance for anterior approach to sciatic nerve

Continuous sciatic nerve block provides successful outcome for painful toe ulcer: case report

Continuous sciatic nerve block provides successful outcome for painful toe ulcer: case report

Case Scenario: Compartment Syndrome of the Forearm in Patient with an Infraclavicular Catheter

Case Scenario: Compartment Syndrome of the Forearm in Patient with an Infraclavicular Catheter

Intermittent sciatic block combined with continuous femoral block for patients undergoing knee arthroplasty

Intermittent sciatic block combined with continuous femoral block for patients undergoing knee arthroplasty

The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study

Background: Patients with critical limb ischemia (CLI) often suffer from severe pain. A continuous peripheral nerve block has been shown to provide effective analgesia for patients having lower limb surgery. We have been administering continuous sciatic nerve block (CSNB) for patients with CLI whose pain could not be relieved by other analgesic tools. The aim of this retrospective study was to investigate the efficacy and safety of CSNB for patients with CLI. Method: We retrospectively investigated 99 patients who received CSNB for the relief of severe pain in the lower limb associated with CLI. Patient demographics, neurological history, complications, and subjective evaluation of the effectiveness of CSNB were investigated from their clinical records. The distal tips of 108 catheters were cultured. Result: One hundred and seventy-two catheters were placed in 99 patients. More than 90% of the patients enjoyed considerable relief of severe pain. The analgesic effect of CSNB was greater in patients with older age and hemodialysis. Thirty-one catheters had positive bacterial colonization. However, no severe infectious complication was found. There was no relationship between the co-existence of diabetes and positive bacterial colonization. We encountered a patient with ASO and diabetes who suffered from persistent motor weakness and hypesthesia even after 3 months of CSNB placement. Conclusions: CSNB provided good pain control for patients with severe pain caused by CLI. Although catheters were frequently found to be colonized, infection at the catheter site was self-limiting even in patients with diabetes.