Nerve Block Group Research Articles

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Background Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome.Methods 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter.Results More patients in group I than in group F could walk < 3 m on the first postoperative day (29/39 vs. 7/37, p < 0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay.Interpretation Peri- and intraarticular application of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage, and duration of this treatment are warranted.

Nerve stimulator guided pudendal nerve blockversus general anesthesia for hemorrhoidectomy

A randomized clinical trial was undertaken to test the hypothesis that patients receiving a nerve stimulator guided pudendal nerve block for hemorrhoidectomy would experience more effective and prolonged postoperative analgesia and shorter hospital stay compared to patients receiving general anesthesia.This was a prospective randomized observer-blinded study. Following Ethics Committee approval and informed consent, 80 patients scheduled for hemorrhoidectomy were randomized to two groups of 40 patients each: general anesthesia alone, or nerve stimulator guided pudendal nerve block. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at predetermined intervals during the postoperative period. Analgesic consumption, time to return to normal activities, patients' and surgeons' satisfaction, and duration of hospital stay were recorded.The guided pudendal nerve block group failed in three patients, requiring their conversion to general anesthesia. Otherwise, patients in the pudendal nerve block group experienced better postoperative pain relief at rest (P < 0.0001), on walking, sitting, and defecation (P < 0.001), reduced need for opioids (11/35 vs 32/37; P < 0.0001), a more rapid return to normal activities (7.2 vs 13.8 days; P < 0.0001) and also a shorter hospital stay (25/35 vs 3/37 outpatient cases; P < 0.0001) compared to the general anesthesia group. Pudendal nerve block was also associated with overall higher patient satisfaction compared to general anesthesia (30/35 vs 9/37; P < 0.0001).Nerve stimulator guided pudendal nerve block is associated with reduced postoperative pain, shortened hospital stay, and earlier return to normal activity compared to general anesthesia for hemorrhoidectomy.

Ankle nerve block-perioperative pain relief in surgery of the forefoot

Background Surgery of the foot induces intense pain in the postoperative periode. Peripheral nerve blocks provide reliable anesthesia for all foot surgery and is associated with an ability to ambulate immediately following surgery. The actual study was performed to evaluate the efficacy of nerve blocks in the postoperative phases of surgery of the forefoot. Method One hundred and sixteen patients were in this prospective study randomized to two groups; group 1 recieved an ankle nerve block with local anesthetics prior to surgery, group 2 recieved spinal or general anesthesia without a nerve block. Pain was evaluated with repeated VAS-scales, total consumption of analgesics were recorded. A record was kept on the requirement of the intraoperative intravenous anesthetic agents. Total hospital care time was recorded. Results The ankle nerve block lowered the requirement of intraoperative intravenous anesthetic agents. The use of oral anelgesics was higher in the control group. The hospital care time was lower in the ankle nerve block group. Conclusion The ankle nerve blocks reduces the consumption of analgesics. Good control of postoperative pain allows for early recovery of these patients. Use of nerve blocks should be encouraged when possible in surgery of the foot.

Comparison of Analgesic Methods for Total Knee Arthroplasty: Metabolic Effect of Exogenous Glucose

This study was set up to assess whether postoperative suppression of gluconeogenesis by dextrose infusion would be influenced by continuous peripheral nerve block (CPNB) with local anesthetics, in comparison with epidural and with intravenous analgesia. Twenty-seven patients, undergoing elective primary total knee arthroplasty for osteoarthritis, were randomly allocated to one of the three groups of 9 patients each: patient controlled analgesia (PCA) with i.v. morphine, epidural with bupivacaine 0.1% and fentanyl 3mug/ml, or continuous femoral and sciatic blocks with ropivacaine 0.2%. Endogenous glucose production, an index of gluconeogenesis, and glucose clearance, an index of whole body glucose uptake, were assessed on the second postoperative day by measuring [6,6-(2)H(2)]glucose kinetics after an overnight fast (fasted state), and during a 3-h period infusion of dextrose at 4 mg/kg/min (fed state). Visual analog scale (VAS) at rest and at knee flexion, use of morphine, mobilization, nutritional intake, and bowel function were also collected. Endogenous glucose production was totally suppressed by 3 h of dextrose infusion in all 3 groups (P < .001) while glucose clearance was unchanged. Blood glucose and insulin increased (P < .001), while glucagon decreased, with the greatest change in the epidural group (P < .05). VAS at rest and at knee flexion was significantly lower in patients receiving epidural and CPNB compared to i.v. morphine (P < .05). Restoration of bowel function, assessed as return of bowel movements, was faster in the CPNB group (P < .05). Excellent analgesia was achieved in the epidural and continuous nerve block groups. Postoperative gluconeogenesis was totally suppressed by dextrose infusion independent of the analgesia technique with no change in glucose utilization.

A Comparison of Epidural Analgesia With Combined Continuous Femoral-Sciatic Nerve Blocks After Total Knee Replacement

Epidural analgesia remains the "gold standard" of pain relief after total knee replacement. However, peripheral nerve block is gaining popularity because the incidence of side effects may be reduced. Our study tests this postulate. Sixty patients were prospectively randomized to receive either epidural infusion or combined continuous femoral and sciatic nerve blocks. Ropivacaine 2 mg/mL plus sufentanil 1 mug/mL was given either epidurally or through the femoral nerve catheter, and ropivacaine 0.5 mg/mL was given through the sciatic nerve catheter using elastomeric infusers (delivering 5 mL/h for 55 h). The primary outcome measure was the total incidence of side effects (urinary retention and moderate to severe degrees of dizziness, pruritus, sedation, and nausea/vomiting on the first postoperative day). Intensity of motor blockade, pain at rest and on mobilization, and rehabilitation indices were also registered for 72 h. One or more side effects were present in 87% of patients in the epidural group whereas only 35% of patients in the femoral and sciatic block groups were affected on the first postoperative day (P = 0.0002). Motor blockade was more intense in the operated limb on the day of surgery and the first postoperative day in the peripheral nerve block group (P = 0.001), whereas the non-operated limb was more blocked in the epidural group on the day of surgery (P = 0.0003). Pain on mobilization was well controlled in both groups and there were no differences in the length of hospital stay. Rehabilitation indices were similar. The results demonstrate a reduced incidence of side effects in the femoral/sciatic nerve block group than in the epidural group on the first postoperative day.

Comparison of Ilioinguinal-iliohypogastric Nerve Block Versus Spinal Anesthesia for Inguinal Herniorrhaphy

This study was carried out to determine the optimal anesthetic technique for use in elective herniorrhaphy. We retrospectively analyzed 126 inguinal hernia repairs. The patients were allocated to one of two groups: an ilioinguinal-iliohypogastric nerve block group (IHNB group, n = 63) and spinal anesthesia group (SA group, n = 63). We recorded information about perioperative and postoperative parameters. There were statistically significant decreases in both mean arterial pressure and pulse rate in the SA group (P < 0.001). None of the patients in the IHNB group required recovery room care. Patients in the IHNB group initiated oral intake (0.31 +/- 0.1 h) more quickly than patients in the SA group (5.74 +/- 0.1 h) (P < 0.001). The time-to-home readiness was significantly lower (14.1 +/- 1.5h) in group IHNB, compared with group SA (42.8 +/- 5.3h) (P < 0.001). First rescue analgesic time postoperatively was 3.30 +/- 0.2 hours in group SA and 2.7 +/- 0.13 hours in group IHNB (P < 0.05). The use of IHNB for patients undergoing herniorrhaphy resulted in a shorter time-to-home readiness, quicker oral intake post surgery, and no need for recovery room care, when compared with the use of SA.

A video study of pain relief during newborn male circumcision.

The purpose of this investigation was to compare the effectiveness of dorsal penile nerve block and topical lidocaine-prilocaine anesthesia techniques for pain relief during circumcision. In total, 18 healthy term newborn males were divided based on anesthesia. The topical lidocaine-prilocaine group had six males undergoing circumcision and three males undergoing a sham procedure. The dorsal penile nerve block group had six males undergoing circumcision and three males undergoing a sham procedure. The procedures were videotaped and viewed by 90 noninvestigator reviewers who scored the infants' pain using the Neonatal Infant Pain Scale and a numeric pain scale. Statistical analysis utilized a P-value of <0.05 as significant. The median Neonatal Infant Pain Scale and numeric pain scores were significantly lower in the dorsal penile nerve block group than in the topical lidocaine-prilocaine group or the sham group (Neonatal Infant Pain Scale: 1.0 (range 0-6) versus 6.0 (range 2-6) versus 4.0 (range 0-6), P < 0.001, respectively; numeric pain scale: 2.0 (range 0-10) versus 8.0 (range 1-10) versus 4.0 (range 0-10), P < 0.001, respectively). In the sham group, procedures with the dorsal penile nerve block had significantly lower pain scores than those with topical lidocaine-prilocaine (Neonatal Infant Pain Scale: 1.0 (range 0-6) versus 5.0 (range 2- 6), P < 0.001; numeric pain scale: 1.0 (0-8) versus 6.0 (range 0-10), P < 0.001). When reviewers were divided by medical background, gender or parental status, no differences in pain scores were observed. The dorsal penile nerve block anesthesia technique for newborn male circumcision was significantly more effective for pain relief than topical lidocaine-prilocaine.

Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery

The reported incidence of shoulder tip pain following laparoscopic surgery varies from 35 to 63%. This study evaluated the analgesic efficacy of either performing a prophylactic suprascapular nerve block with bupivacaine or applying a piroxicam patch to the skin over both shoulders for the relief of shoulder tip pain after laparoscopy. Sixty healthy informed female patients were randomly assigned to one of three groups: (a) a control group (n = 20), no treatment; (b) a suprascapular nerve block group (n = 20) in which a bilateral suprascapular nerve block was performed before induction of anaesthesia with 5 mL 0.5% bupivacaine with epinephrine; and (c) a piroxicam patch group (n = 20) in which a 48 mg piroxicam patch on the skin of each shoulder was applied before induction of anaesthesia. All patients received a total intravenous anaesthesia technique with propofol, fentanyl and vecuronium. Shoulder tip and wound pain were recorded on a visual analogue pain scale at five time intervals for 24 h after surgery. A total of 80% of patients in the control group, 75% in the suprascapular nerve block group and 45% in the piroxicam patch group complained of shoulder tip pain during the recording period (P < 0.05). The scores for shoulder tip pain in the piroxicam patch group were significantly lower compared with the control group at 3, 6 and 12 h, and compared with the suprascapular nerve block group at 6 and 12 h. The need for analgesics was also significantly lower in the piroxicam patch group compared with the other two groups. Prophylactic piroxicam patches are effective and safe for the relief of shoulder tip pain after laparoscopy. Bilateral suprascapular nerve block is not effective in this setting.

Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children

Ilioinguinal and iliohypogastric (IG-IH) nerve block has been widely used in children undergoing inguinal hernia repair. This technique may provide insufficient analgesia for intraoperative management as the inguinal region may receive sensory innervation from genitofemoral nerve. We proposed that addition of a genitofemoral nerve block might improve the quality of analgesia. Ninety-eight children undergoing inguinal hernia repair were assigned randomly to receive either IG-IH nerve block (Group I) or IG-IH and genitofemoral nerve blocks (Group II). Systolic arterial pressure (SAP) and heart rate (HR) were recorded before surgery (control), after skin incision, at sac traction and at the end of surgery. Postoperative analgesic requirements and incidence of complications were recorded until discharge. At sac traction, SAP and HR were significantly higher in Group I (P<0.05), and the incidence of episodes of increased HR was also significantly higher in Group II (29 vs 12%, respectively, P<0.05). There were no significant differences in SAP and HR at other time points, postoperative analgesic requirements or incidence of complications between the groups. The benefit of the additional genitofemoral nerve block to IG-IH nerve block was limited only to the time of sac traction without any postoperative effect. This suggests there is little clinical benefit in the addition of a genitofemoral nerve block.

Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain

Based on our institution's initial results that reflected reduced postoperative pain using a modified pudendal nerve block technique, we conducted a prospective, randomized, double-blind study to investigate whether a combination of general anesthesia and bilateral nerve stimulator guided pudendal nerve blocks could provide better postoperative pain relief compared to general anesthesia alone or in combination with placebo nerve blocks. Following Ethical Committee approval and informed consent 90 patients scheduled for hemorrhoidectomy were randomized to three different groups of 30 patients each: general anesthesia alone, general anesthesia plus nerve stimulator guided pudendal nerve block or general anesthesia plus placebo nerve blocks. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at predetermined time intervals during the postoperative period. Total amount of analgesics, time to return to normal activities and patient satisfaction were also recorded. The pudendal nerve block group was found to have better postoperative pain-relief (P < 0.005), reduced need for analgesics (P < 0.05), and also a more rapid return to normal activities (P < 0.001) compared to general anesthesia alone or in combination with placebo blocks. The pudendal nerve block group was also associated with significantly higher patient satisfaction (P < 0.001) compared to the other two groups. A combination of general anesthesia and nerve stimulator guided pudendal nerve block showed significantly reduced postoperative pain, shortened hospital stay, and earlier return to normal activity. Thus, this technique deserves more widespread use in patients undergoing hemorrhoidectomy.

Suprascapular Nerve Block versus Steroid Injection for Non-Specific Shoulder Pain

Shoulder pain is a common complaint in elder population and may cause an important functional disability. The aim of this study was to compare the effects of suprascapular nerve block with those of steroid injection in patients with non-specific shoulder pain. A total of 60 patients with shoulder pain lasting for more than four weeks were included in this study. After 1:1 randomization, patients were included in the steroid group (n=30) or the suprascapular nerve block group (n=30). Single injection was performed in both groups. All patients were evaluated before treatment, within one week after treatment, and one month later, in terms of pain, range of motion (ROM) (flexion, abduction, internal and external rotations, and total constant shoulder ROM score), satisfaction, and disability (Pennsylvania shoulder scale function score). Steroid injection was applied at two points in order of lateral and anterior routes. Suprascapular nerve block with lidocaine was applied at the suprascapular notch. No difference was noted in the indicated parameters before the treatment between the groups (p >0.05). The difference in all follow-up parameters was statistically significant in the assessment periods in both groups (p <0.05). No method was found to be superior to each other (p >0.05). No complications occurred in suprascapular nerve block in contrary to steroid injection. We suggest that suprascapular nerve block can be considered the preferred treatment for non-specific shoulder pain because of being as effective as steroid injection with rare side effects.

Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery

Background and objective: The reported incidence of shoulder tip pain following laparoscopic surgery varies from 35 to 63%. This study evaluated the analgesic efficacy of either performing a prophylactic suprascapular nerve block with bupivacaine or applying a piroxicam patch to the skin over both shoulders for the relief of shoulder tip pain after laparoscopy. Methods: Sixty healthy informed female patients were randomly assigned to one of three groups: (a) a control group (n = 20), no treatment; (b) a suprascapular nerve block group (n = 20) in which a bilateral suprascapular nerve block was performed before induction of anaesthesia with 5 mL 0.5% bupivacaine with epinephrine; and (c) a piroxicam patch group (n = 20) in which a 48 mg piroxicam patch on the skin of each shoulder was applied before induction of anaesthesia. All patients received a total intravenous anaesthesia technique with propofol, fentanyl and vecuronium. Shoulder tip and wound pain were recorded on a visual analogue pain scale at five time intervals for 24 h after surgery. Results: A total of 80% of patients in the control group, 75% in the suprascapular nerve block group and 45% in the piroxicam patch group complained of shoulder tip pain during the recording period (P < 0.05). The scores for shoulder tip pain in the piroxicam patch group were significantly lower compared with the control group at 3, 6 and 12 h, and compared with the suprascapular nerve block group at 6 and 12 h. The need for analgesics was also significantly lower in the piroxicam patch group compared with the other two groups. Conclusions: Prophylactic piroxicam patches are effective and safe for the relief of shoulder tip pain after laparoscopy. Bilateral suprascapular nerve block is not effective in this setting.

Is Periprostatic Local Anesthesia For Transrectal Ultrasound Guided Prostate Biopsy Associated With Increased Infectious Or Hemorrhagic Complications? A Prospective Randomized Trial

Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method. A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy. The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group. Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.

Evaluation of techniques for lignocaine hydrochloride analgesia of the velvet antler of adult stags

Aim: To evaluate the effectiveness of various routes of administration and doses of local anaesthetic (LA) to provide analgesia of the velvet antler of adult stags. Methods: In Experiment 1, antlers from 50 red deer stags, ≥2-years-old were allocated to 1 of 4 treatment groups (n = 25 antlers/group) to receive injections with 2% lignocaine hydrochloride as follows: High-dose (1 ml/cm pedicle circumference) or Low-dose ring-block (0.4 ml/cm pedicle circumference) or; High-site or Low-site regional nerve block (5 ml per site, both of which included the auriculopalpebral nerve). An electrical stimulus was applied before application of LA and then each min for up to 4 min after LA injection. If no response was observed, analgesia was tested with a saw cut. If no response occurred, the antler was cut at that time. If the animal responded, a further wait time was applied until 4 min had elapsed, at which time observations ceased. In Experiment 2, 10 primary and 50 re-growth antlers were given a High-dose ring-block and tested with a saw cut after 1 min (n = 30) or 2 min (n = 30). If no response occurred, the antler was removed. If a response occurred, further 1-min wait periods were applied. Results: In the High-dose ring-block and High-site nerve-block groups, 24/25 and 21/25 antlers were removed without response by 2 min, compared with 20/25 and 15/25 antlers in the Low-dose ring-block and Low-site nerve-block groups, respectively. The High-dose ring-block provided more effective analgesia after 3 min than the Low-dose ringblock, as assessed by the number of stags that did not respond to the electrical stimulus (p = 0.008), or subsequent antler removal (p = 0.050). The numbers of antlers removed without response after 1 or 2 min were greater using the High-site nerve-block than the Low-site nerve-block (p = 0.002 and p = 0.037, respectively). In all but the High-dose ring-block group, at least 1 stag required further LA after 4 min, before antler could be humanely removed. In Experiment 2, stags reacted to a saw-cut test on 6/30 antlers, 1 min after a High-dose ring-block, compared with 1/30 antlers after 2 min (p = 0.051). Conclusion: The High-dose ring-block produced the most effective and rapid analgesia. Clinical relevance: A High-dose ring-block with a 2-min wait period should be the preferred method for achieving local analgesia for velvet antler removal.

Incidence of phrenic nerve block and hypercapnia in patients undergoing carotid endarterectomy under cervical plexus block.

Deep cervical plexus blockade blocks the second, third and fourth cervical nerve roots. The phrenic nerve arises from C3, C4, C5 and should therefore be commonly blocked with cervical plexus blockade. The aim of this study was to report the incidence of phrenic nerve block and to assess the effect of this on arterial carbon dioxide tension (PaCO2) in premedicated and sedated patients. Forty patients were studied, blood gases being taken on the day before surgery, immediately before performing the block and then every 20 minutes until the operation was completed. Fluoroscopy was used to determine ipsilateral hemidiaphragmatic dysfunction due to phrenic nerve block. The patients were then divided into two groups of analysis. Group A patients had evidence of phrenic nerve block, Group B patients had no evidence of phrenic nerve block. Fluoroscopy showed that 22 patients (55%) had evidence of phrenic nerve block (Group A), 18 patients showed no change (Group B). PaCO2 levels increased in both groups following premedication, from 41 +/- 5 mmHg (mean +/- SD) to 46 +/- 5 mmHg in Group A, and 41 +/- 4 mmHg in Group B; twenty minutes after cervical plexus block the PaCO2 rose to 49 +/- 6 mmHg in Group A, and 48 +/- 6 mmHg in Group B. These changes were not statistically significantly different when the two groups were compared.

Peripheral Nerve Blocks Improve Analgesia After Total Knee Replacement Surgery

Total knee replacement (TKR) produces severe postoperative pain.Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled IV morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. Implications: Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total knee replacement surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits. (Anesth Analg 1998;87:93-7)

Combined popliteal and posterior cutaneous nerve of the thigh blocks for short saphenous vein stripping in outpatients: An alternative to spinal anesthesia

Study Objective: To compare a combination of peripheral nerve blocks with spinal anesthesia in ambulatory patients undergoing short saphenous vein stripping. Design: Prospective, randomized study. Setting: University hospital. Patients: 28 ASA physical status I and II ambulatory surgery patients undergoing short saphenous vein stripping. Interventions: 14 patients received a popliteal block (sciatic nerve block at the popliteal fossa) using 30 ml of alkalinized 3 % chloroprocaine and a posterior cutaneous nerve of the thigh block with 10 ml of 1% lidocaine. The 14 patients who were randomized to the spinal anesthesia group received 65 mg of 5% hyperbaric lidocaine. Measurements and Main Results: There were no significant differences in age and gender between the two groups (mean age 53 ± 13 years, 8 men and 20 women). Patients in the peripheral nerve block group recovered significantly faster in phase 1 of the postanesthesia care unit (PACU) (67 ± 10 min vs. 122 ± 50 min, p < 0.01) and were discharged home sooner (222 ± 53 min vs. 294 ± 69 min, p < 0.01) than the patients in the spinal anesthesia group. Conclusions: The combination of popliteal and posterior cutaneous nerve of the thigh blocks provided adequate anesthesia and a faster recovery profile with a similar subjective acceptance of both anesthetic techniques in ambulatory patients undergoing short saphenous vein stripping in the prone position.

Continuous Popliteal Sciatic Nerve Block

Our study describes an original technique of continuous popliteal sciatic nerve block (CPSB) (Group A, 60 patients) and compares its analgesic efficacy after foot surgery with intramuscular (IM) opioids (Group B, 15 patients) and intravenous patient-controlled analgesia (IV PCA) with morphine (Group C, 45 patients). CPSB was performed using Singelyn's landmarks. The sciatic nerve was localized with a short-beveled needle connected to a peripheral nerve stimulator. A 20-gauge catheter was placed at the same depth as the needle with a Seldinger technique. Thirty milliliters of 1% mepivacaine with epinephrine 1/200,000 was injected and followed by a continuous infusion of 0.125% bupivacaine with sufentanil 0.1 microgram/mL and clonidine 1 microgram/mL at 7 mL/h for 48 h. Postoperative analgesia (intravenous [IV] propacetamol [PRO] and/or IM piritramide [DIPI]) was standardized. Postoperative pain score (PPS), supplemental analgesia, and side effects were noted. CPSB was easy to perform in 55 patients (92%). In Group A, highest and mean PPS were significantly lower, and the mean dose of PRO was reduced by 62% and 36% when compared with Group B and C, respectively. Only 8% of patients required postoperative opioid in Group A compared with 91% and 100% in Groups B and C, respectively. No immediate or delayed complications other than postoperative technical problems (kinked or broken catheter 25%) were noted in Group A. In conclusion, CPSB is easy to perform, safe, and a more efficient technique than parenteral opioid for providing postoperative analgesia after foot surgery.

Continuous Popliteal Sciatic Nerve Block

Our study describes an original technique of continuous popliteal sciatic nerve block (CPSB) (Group A, 60 patients) and compares its analgesic efficacy after foot surgery with intramuscular (IM) opioids (Group B, 15 patients) and intravenous patient-controlled analgesia (IV PCA) with morphine (Group C, 45 patients). CPSB was performed using Singelyn's landmarks. The sciatic nerve was localized with a short-beveled needle connected to a peripheral nerve stimulator. A 20-gauge catheter was placed at the same depth as the needle with a Seldinger technique. Thirty milliliters of 1% mepivacaine with epinephrine 1/200,000 was injected and followed by a continuous infusion of 0.125% bupivacaine with sufentanil 0.1 micro g/mL and clonidine 1 micro g/mL at 7 mL/h for 48 h. Postoperative analgesia (intravenous [IV] propacetamol [PRO] and/or IM piritramide [DIPI]) was standardized. Postoperative pain score (PPS), supplemental analgesia, and side effects were noted. CPSB was easy to perform in 55 patients (92%). In Group A, highest and mean PPS were significantly lower, and the mean dose of PRO was reduced by 62% and 36% when compared with Groups B and C, respectively. Only 8% of patients required postoperative opioid in Group A compared with 91% and 100% in Groups B and C, respectively. No immediate or delayed complications other than postoperative technical problems (kinked or broken catheter 25%) were noted in Group A. In conclusion, CPSB is easy to perform, safe, and a more efficient technique than parenteral opioid for providing postoperative analgesia after foot surgery. (Anesth Analg 1997;84:383-6)

Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia

Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the intercostal nerve block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.