Popliteal Fossa Block Research Articles

Comparative Study of Ultrasound Guided Popliteal Fossa Block versus Ankle Block as Primary Anaesthesia for Forefoot Operative Procedure

Regional anaesthesia can be used as the primary anaesthesia method and also as an adjunct to control postoperative pain following forefoot surgeries. The purpose of this study was to compare the overall efficacy of ultrasound guided popliteal fossa block to ankle block as the primary anaesthesia for forefoot surgeries. It was an observational study including 112 participants. They were divided into 2 groups, Group PFB: popliteal fossa block with 20 ml 0.5%bupivacaine and 10ml2% lignocaine (total 30ml) & Group AB: ankle block with 20 ml 0.5% bupivacaine and 10ml 2% lignocaine (total 30ml). The primary outcome variables were VAS score and rescue analgesia and secondary outcome variables were hemodynamics (heart rate, MAP). P value < 0.05 was considered significant. Our study showed a reduction in post-operative visual analogue scale scores in PFB group (5.21± 0.834) as compared to AB group (7.09 ± 0.815) with a P value of 0.0001 which was statistically significant. The mean first rescue analgesia time for PFB group was 12.46±1.59 while for AB group was 6.93± 0.82 with P value of 0.0001 which was statistically significant. Both AB and PFB provides sufficient anaesthesia for forefoot surgeries. However, popliteal fossa block is preferred over ankle block for forefoot surgeries due to longer post-operative analgesia

Peripheral Nerve Block Compared to Intra-Articular Injection for Post-Operative Pain Control in Total Ankle Arthroplasty: A Randomized, Controlled, and Non-Inferiority Trial

Category:Ankle Arthritis; Ankle; OtherIntroduction/Purpose:Ankle arthritis is associated with debilitating pain and chronic disability. Total ankle arthroplasty (TAA) is increasingly performed to treat end-stage arthritis resulting in favorable clinical outcomes. Peripheral nerve blocks (PNB) are widely used for post-operative pain management; however, PNB can lead to post-operative neuropathic complications. Intra- articular injections (IAI) have been widely reported as an alternative to PNB in total knee arthroplasty, resulting in lower post- operative narcotic consumption and accelerated functional recovery. Little information exists on patient outcomes following IAI in TAA. The purpose of this study was to assess the effectiveness and tolerability of IAI compared to PNB for pain control, measured by oral morphine milligram equivalents (MME) and a Visual Analogue Pain Scale (VAS), following TAA.Methods:We conducted a prospective, randomized, non-inferiority study involving 51 opioid naïve adults undergoing primary, unilateral TAA. Participants were randomized to IAI joint cocktail containing anesthetic and steroid at the completion of the TAA (n=26), injected in four joint capsule locations, or PNB (n=25). PNB included a single popliteal fossa block of the sciatic nerve and adductor canal block of the distal femoral nerve. Primary outcomes were mean difference in oral post-operative MME, via inpatient record and patient daily narcotic diaries, and post-operative pain measured by the VAS (0-100mm) at 24 hours and 2 weeks post-TAA. IAI was considered non-inferior to PNB if mean difference in consumption of narcotics was less than 30 MME (24 hour) and 75 MME (2 weeks), and the mean difference in pain was less than 15mm on the VAS using the upper limit of one- sided 95% confidence intervals (UCI) for increase in MME and VAS scores.Results:There were 39 patients with complete data. Mean oral MME in 24 hours was 50.4 (sd = 38.1) in the IAI group (n=22) versus 52.9 (sd = 48.1) in PNB (n=17) with -2.4 MME mean difference (UCI 20.8). Mean VAS at 24 hours was 25.6 (sd = 25.1) in IAI compared to 25.4 (sd = 29.2) in PNB. Mean difference in VAS at 24 hours was 0.22 (UCI 14.9). Mean two week post- VAS was 13.3 (sd = 17.2) in IAI compared to 15.1 (sd = 21.2) for PNB with mean difference of -1.8 (UCI 8.5). All demonstrate non- inferiority. At two week post- IAI reported 384.6 MME (sd = 491.0) and PNB 319.2 (sd = 323.7) with 65.5 MME difference (UCI 303.6), not supporting non-inferiority.Conclusion:IAI is non-inferior to PNB in the first 24 hours after TAA as measured by oral narcotic consumption and patient-self reported pain. At two week post-TAA, IAI resulted in non-inferior pain scores; however, non-inferiority was not confirmed for oral narcotic consumption due to the high variability in documented use. This study suggests IAI is effective for controlling immediate post-operative pain without introducing the neuropathic complications associated with PNB.

Ankle Block versus Popliteal Fossa Block as Primary Anesthesia for Forefoot Surgical Procedures

Category: Midfoot/Forefoot Introduction/Purpose: Postoperative pain is often difficult to control with oral medications, often times requiring large doses of opioid analgesia. The purpose of this study is to compare the analgesic effects of an ankle block (AB) to a single shot popliteal fossa block (PFB) for patients undergoing orthopaedic forefoot procedures. Our hypothesis is that a PFB would have fewer conversions to general anesthesia, less pain medication requirements and better pain control in the immediate postoperative period. Methods: Patients having elective outpatient orthopaedic foot and ankle procedures were invited to participate. Patients with Diabetes, peripheral neuropathy, bilateral procedures, allergy to local anesthetics and procedures proximal to chopart’s joint were excluded. Patients were randomized to either an ultrasound guided AB or PFB by an anesthesiologist pre-operatively. Intraoperative conversion to general anesthesia and PACU opioid requirements were converted to mg of Morphine and then recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until postoperative day (POD) 2. Patients rated their block experience on a 1-5 scale, with 5 being very effective. Results: A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single shot PFB. No difference in the conversion to general anesthesia was seen between the two groups (12 patients in AB v. 10 in PFB, p>0.05), with the most common reason being movement without pain in both groups. PACU morphine requirements were significantly reduced in the PFB group (p=0.004). The VAS was significantly lower for the PFB patients for all time points 24 hrs after surgery (p < 0.01). Individual and combined complication rates were similar between both groups (AB 11.4% v PFB 10.1%, p>0.05). The PFB lasted longer (14.5 hrs v 20.9 hrs, p < 0.001). Both groups felt their block was effective (AB 4.79/5 v PFB 4.82/5, p=0.68) Conclusion: Regional anesthesia can be a safe and reliable adjunct to perioperative pain management with high patient satisfaction in patients undergoing elective forefoot procedures. However, better pain management and decreased opioid requirements in the immediate perioperative period was seen in patients having a popliteal fossa block when compared to an ankle block.

A double-blind randomized controlled trial comparing dexamethasone and clonidine as adjuvants to a ropivacaine sciatic popliteal block for foot surgery.

Background and aimsA 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.MethodsIn 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.ResultsCompared 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).ConclusionAddition of DXM and clonidine to ropivacaine significantly prolonged the duration of postoperative sensory and motor block.

Combination of Sacral Spinal Anesthesia and Popliteal Fossa Block on Surgical Side for Below Knee Surgery

Background: The beneficial effects of two central neuraxial blocks in combined form are well acceptable and well tolerable by patients. Beneficial effects of both components are utilized, minimizing their drawbacks. Aims: Our study is designed to evaluate the use of peripheral ( popliteal fossa block ) and central nerve block (spinal) in combined form for below knee surgical procedures. Methods: 30 patients of 60-90 years old with ASA physical status of classification II and III were selected for below knee surgical procedures undergoing popliteal fossa block 20 minutes before sacral spinal anesthesia. The popliteal fossa block was achieved with 30 ml of o.375% injection bupivacaine through lateral approach at the level of upper broader of patella with help of nerve stimulator needle. Sacral spinal anesthesia was introduced through second dorsal foramen of sacrum by intrathecal administration of three ml of 0.5% injection bupivacaine. Results: The hemodynamic stability along with profound and prolonged analgesia before, during and after surgical procedure is the most interesting characteristic feature of this study. Preoperative popliteal fossa block induces analgesic effect at the fracture site and contributes comforts to patients at the time of positioning the patient for administration of sacral spinal anesthesia. It acts as an adjuvant to spinal anesthesia like intrathecal administration of fentanyl or clonidine with the central depression. Conclusion: It provides analgesia before spinal as preoperative medication without central depression, cardiovascular stability during surgical procedures under spinal anesthesia and prolonged analgesia after surgery.

Relationship Between Glycosylated Hemoglobin Level and Sciatic Nerve Block Performance in Diabetic Patients

The objective of the present study was to explore the effects of deficiencies in glucose regulation on the onset, regression, and block performance times in a group of patients with diabetes-related foot problems. Forty-eight patients with American Society of Anesthetists physical status 2-4 undergoing foot and ankle surgery with a popliteal fossa block were prospectively studied. Patients were stratified into cohorts based on 3 groups according to their HbA1c levels: group 1 (n = 15), HbA1c 5%-6%; group 2 (n = 16), HbA1c 7%-8%; group 3 (n = 17), HbA1c 9%-10%. A standardized local anesthetic mixture containing 10 mL of 2% prilocaine and 10 mL of 0.5% levobupivacaine was used in all study groups. The primary outcome of the study was the time for regression of the sensory block. The onset times of sensory and motor blocks in group 3 were significantly longer than those in groups 2 and 1. Motor block regression time differed significantly between groups (P = .04), being longer in group 3 compared with group 1. In group 3, the sensory block regression time and the time of first analgesic use were significantly longer than the times in groups 1 and 2. We found that sensory block regression time was longer in diabetic patients with poor glycemic control than in the patients with better glycemic control. Longer block performance time, probably due to reduction in sensory and motor conduction velocity in diabetic patients with poor glycemic control, should be taken into consideration when peripheral nerve blocks are used. Level II, prospective comparative study.

Distal Tourniquet or Leg Position After Injection Enhances the Efficacy of Sciatic Nerve Blockade by the Popliteal Approach

In this study, we hypothesized that leg positioning and distal tourniquet application, when compared with neutral positioning of the leg, alters the efficacy of sciatic nerve block performed by the double-stimulation technique. Ninety randomized, consecutive, ASA physical status I to III patients undergoing foot and ankle surgery with a popliteal fossa block (using a double-stimulation technique with the patient in prone position) were prospectively studied. Patients were randomized to have the blocked leg either kept in a neutral position immediately after the patient was turned supine (group 1), flexed 45 degrees at the thigh and maintained in that position for 15 minutes (group 2), or have a distal tourniquet applied with the leg in a neutral position and inflated during injection of the local anesthetic with the patient supine (group 3). A standardized local anesthetic mixture containing 15 mL of 2% prilocaine and 15 mL of 0.5% levobupivacaine was used in all study groups. The onset times for sensory and motor blocks were shorter, and the time to recovery of blocks was longer, postprocedure in both group 2 and 3. Similar beneficial effects might be reached with the application of a distal tourniquet during injection or elevating the patient's leg turned supine immediately after sciatic nerve block with a popliteal approach by a double-injection technique. We suggest that using the leg-up position or application of a distal tourniquet for sciatic nerve block may lead to a more proximal distribution of the local anesthetic and may result in a faster onset of sensory and motor blocks as well as longer duration of blockade.

Several "Correct" Approaches to Nerve Stimulator-Guided Popliteal Fossa Block

Several "Correct" Approaches to Nerve Stimulator-Guided Popliteal Fossa Block

Clonidine and Analgesic Duration After Popliteal Fossa Nerve Blockade: Randomized, Double-Blind, Placebo-Controlled Study

We tested the hypothesis that 100 microg clonidine added to 0.375% bupivacaine would prolong the duration of analgesia from popliteal fossa nerve blockade. Ninety-nine patients scheduled for hospital admission after foot or ankle surgery entered this randomized, double-blind, placebo-controlled trial. Patients received a popliteal fossa block (nerve stimulator technique, via the posterior approach) using 30 mL 0.375% bupivacaine, with epinephrine. Patients were randomized to receive no clonidine, 100 microg clonidine IM, or 100 microg clonidine with bupivacaine for the popliteal block. Patients also received a combined spinal-epidural anesthetic, a saphenous nerve block, and postoperative IV patient-controlled analgesia. The primary outcome was patient-reported duration of analgesia. Duration of analgesia was statistically longer in the block clonidine group (18 +/- 6 h for clonidine with bupivacaine vs 14 +/- 7 h for IM clonidine and 15 +/- 7 h for control, P = 0.016 for control vs clonidine with bupivacaine). Pain scores, analgesic use, and side effects attributable to pain management were similar among groups. Clonidine significantly prolongs the analgesic duration after popliteal fossa nerve blockade with bupivacaine.

Regional anaesthesia techniques for orthopaedic surgery

Background : In recent years, there has been a significant resurgence of interest in regional anaesthesia techniques. Despite various advantages, regional anaesthesia is not used to its full potential in orthopaedic surgeries. Methods : This study was conducted to evaluate the efficacy and safety of regional anaesthesia techniques in 400 consecutive patients, posted for orthopaedic surgeries in a tertiary care centre. Data was analysed for patient profile, type of surgery, nature of anaesthetic technique used, success rate, complications and satisfaction level of patients. Result : Age of patients ranged from three months to 92 years with male preponderance (84.5 %). Regional anaesthesia was used in 85% cases. Most frequently used technique for upper limbs was supraclavicular brachial plexus block (12.05 %) followed by interscalene block (5.58 %) and intravenous regional anaesthesia or Bier's block (2.64 %). For lower limbs, subarachnoid block was used in 50 % cases followed by combined spinal-epidural technique (21.47 %) and paravertebral block (4.70 %). Less commonly used techniques like lumbar plexus block, popliteal fossa block, sciatic + femoral nerve blocks were found to be useful but incidence of partial blocks was high. Overall success rate was 96.17 %. In 22.05 % cases supplementation with analgesic / sedative was needed, whereas in 3.82 % cases, technique was converted into general anaesthesia. There was no major complication. Six patients had reversible sensory neuropathy. In 91.64 % cases, satisfaction level was good to excellent. Conclusion : Skilfully performed techniques in regional anaesthesia can facilitate excellent surgical anaesthesia and postoperative pain management.

Piezoelectric Vibrating Needle and Catheter for Enhancing Ultrasound-Guided Peripheral Nerve Blocks

Ultrasound imaging has been used for performing single-injection peripheral nerve blocks and continuous catheters. One limitation with current technology is the inability to confirm the location of the needle or catheter tip. We describe a new needle and catheter design that permits distal tip visualization using color flow Doppler. An 18-gauge 100-mm insulated Tuohy needle and a 20-gauge 50-mm polyamide catheter (open tip) with a Teflon-coated steel stylet (B. Braun, Bethlehem, PA) were customized by adhering in place two piezoelectric actuators. These created 1-8 kHz vibrations when coupled to a function generator (FG502, Tektronix, Richardson, TX) and a 100 W audio amplifier (R3000, KLH, Sun Valley, CA). Mimicking a lateral popliteal fossa block, the needle and catheter were inserted into the leg of an unembalmed cadaver. When activated, the tip of each was highlighted in color when scanned in the short axis using the color Doppler mode of a two-dimensional ultrasound and a 12 MHz L38 probe (MicroMaxx, Sonosite, Bothell, WA). Vibration technology may be a useful adjunct while performing ultrasound-guided regional anesthesia. Further study evaluating its usefulness and safety in live tissue is warranted.

“Gapped Supine” Position for Ultrasound Guided Lateral Popliteal Fossa Block of the Sciatic Nerve

“Gapped Supine” Position for Ultrasound Guided Lateral Popliteal Fossa Block of the Sciatic Nerve

Similar Analgesic Effect After Popliteal Fossa Nerve Blockade with 0.375% and 0.75% Bupivacaine

This study tested the hypothesis that increasing the concentration of bupivacaine from 0.375 to 0.75% would increase the duration of postoperative analgesia by 3 h. Seventy patients scheduled for hospital admission after foot or ankle surgery gave consent to enter this prospective randomized trial. Patients were randomly assigned to receive a popliteal fossa block (posterior approach) using 30 cc of either 0.375% or 0.75% bupivacaine, with epinephrine. Patients also received a neuraxial anesthetic and postoperative intravenous patient-controlled analgesia. Patient characteristics, duration of analgesia, pain scores, use of analgesic medications, and side effects of analgesic therapy were determined. Duration of analgesia was similar with both concentrations of bupivacaine (0.375% 14 +/- 8 h, 0.75% 13 +/- 6 h; mean +/- SD). Pain scores were the same for both groups on the first postoperative day (3 of 10 at rest, 5 with therapy). Analgesic use and side effects attributable to pain management did not differ between groups. In conclusion, postoperative analgesia was not affected by the concentration of bupivacaine used for the nerve block. There was no benefit to increasing the concentration of bupivacaine above 0.375% for single-injection popliteal fossa nerve blockade when performed for postoperative analgesia.

A study of regional nerve blocks and local anesthetic creams (Prilox ®) for donor sites in burn patients

Background Burn patient requires multiple visits to the operation theatres and undergoing anesthesia with its attendant risks and post anesthesia recovery. It is possible now with the availability of local anesthetic creams like Prilox ® to conduct these procedures in the minor OT without any discomfort to the patient. Materials and methods Hundred patients of post burn raw areas were selected. These patients had at least one area of healthy skin on anterior, medial or lateral thigh. No patient had a known drug allergy. The age group varied from 5 to 75 years with no bias towards any sex. These patients were then given anesthesia according to the group, and were assessed for the ease of grafting, amount of graft being harvested, subjective pain score, post operative pain relief and any post operative complication. The nerve block technique being used was either femoral and/or LCT block or 3-in-1 block and popliteal fossa block. Results Both the group of patients had a virtual painless process of skin grafting. It is safe in selected patients to combine the two techniques in order to harvest larger areas. Discussion Both techniques of local anesthestic creams and nerve block are safe and convenient to use. Nerve blocks are more useful where larger grafts are required, the creams being more useful in children and where less graft is required.

Popliteal fossa block

An understanding of the anatomy of the popliteal fossa is essential in order to successfully block the nerves of the lower extremity below the knee. The innervation of the lower extremity originates from the lumbar and sacral plexuses. The sciatic nerve, which is formed from the sacral plexus, innervates the hamstrings and all the muscles of the lower leg and foot. With one exception, the saphenous nerve, all the sensation of the lower leg is via branches of the sciatic nerve. In the past, all techniques for blocking nerves in the popliteal fossa involved the use of a stimulating needle and a nerve stimulator to elicit a characteristic dorsi or plantar flexion in the foot. However, recently interest has centered on the use of ultrasonic guidance to facilitate the placement of regional blocks. Needle guidance and block placement with ultrasound offers the following distinct advantages over all other techniques: precise location of nerves, avoidance of major vessels or organs, direct visualization of the needle and spread of the local anesthetic solution and to make peripheral blocks possible in the morbidly obese where landmarks are obscured. This manuscript provides detailed guidance in the use of ultrasound to facilitate the placement of the popliteal fossa block.

Ultrasound-guided popliteal block demonstrates an atypical motor response to nerve stimulation in 2 patients with diabetes mellitus

Background and Objectives: Nerve stimulation is a useful technique to identify peripheral nerves before blockade. We report 2 cases of the failure of nerve stimulation to accurately localize the sciatic nerve in patients with diabetes mellitus undergoing outpatient foot procedures. We also introduce a novel approach to performing a popliteal fossa block using ultrasound guidance. Case Report: Ultrasound-guided popliteal fossa blocks were performed in 2 patients with diabetes mellitus. Both patients failed to develop an appropriate motor response or paresthesia to nerve stimulation. The needle positions were confirmed by ultrasound guidance and injections of local anesthesia were made uneventfully. Appropriate surgical anesthesia was established and the procedures were performed uneventfully. Conclusion: Ultrasound facilitated the accurate localization of the sciatic nerve in 2 patients with diabetes mellitus. Neither patient had a paresthesia or muscle twitch below 2.4 mA. There is theoretical concern that patients with underlying neuropathy, such as patients with diabetes mellitus, may have an altered response to either motor or sensory stimulation.

Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Edition.

Mayo Clinic, Rochester, Minnesota. tiede.jeffrey@mayo.eduClinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Edition. Senior Editor: William E. Hurford. Lippincott, Williams &amp; Wilkins, Baltimore, 2002. Pages: 786. Price: $39.95. ISBN: 0-7817-3718-4.Stumbling through the darkness, I silence the piercing blare of the alarm clock. It is 4:45 am, but I've been awake for hours. Today is the first day of my CA-1 yr. After scampering off to work, preparing my room, and reviewing the first patient's history, the moment of judgment has come. It's time to talk with the staff. The anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), student CRNAs, surgeons, surgical techs, scrub nurses, and janitors know more about anesthesiology than I do. I have tried to prepare for this day, but my mind is a blank slate. Do not fear! All is well! I have just spent the past 5 min with my copy of Clinical Anesthesia Procedures of the Massachusetts General Hospital , and I will be able to continue this masquerade as an anesthesia provider until my knowledge catches up with my responsibility.The previous edition of Senior Editor William Hurford's book has rescued me on many occasions, for example, by contributing to the relative ease of my first popliteal fossa block. The topics presented in this book are well organized and concise, but detailed enough to be clinically useful in the trenches of the operating rooms. For example, chapter six provides almost two pages on carcinoid syndrome. From pathophysiology to preoperative management to anesthetic considerations, the authors provide a useful summary that is ideal for the clinician who is venturing down paths not frequently traveled. This book is not an exhaustive reference for the omniscient; rather, it is a conveniently packaged, quick reference for both those in training and those in practice. In addition to anesthetic considerations for various different diseases, the book supplies numerous convenient tables ranging from congenital cardiac lesions to opioid pharmacology. These tables help to retrieve knowledge that we all know as anesthesia providers but which may have drifted to the back of one's mind.Many trainees have benefited from previous editions of this book. The sixth edition offers many new and updated chapters. The anesthesia-related drug index located in the back of the book has been expanded and continues to be a valuable resource. The chapter on adult, pediatric, and newborn resuscitation has been rewritten based on the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Chapters describing anesthesia for bariatric surgery, transplantation, and ambulatory anesthesia are but just a few of the other changes in this edition. One particularly interesting and unique chapter focuses on complementary and alternative medicine, including a nice list of often-used herbs and their anesthetic implications. Imagine what your staff would say if you told them that the tumeric root your patient is taking causes a free water diuresis. You'll be a star!I, like the majority of my colleagues, have embraced the computer age and purchased a Personal Digital Assistant (PDA). From pharmacopeias to regional texts, the array of information available for downloading seems to be endless. But whenever I want to know ED95of cis-atracurium or the Crawford classification for descending thoracic aortic aneurysms, or I want a quick review of a topic such as pediatric anesthesia, I still turn to Clinical Anesthesia Procedures of the Massachusetts General Hospital . This book is not intended to be a complete reference. But from machine checkout to conduct of bypass, it provides a conveniently packed resource that both literally and figuratively belongs in the back pockets and carts of trainees and practicing clinicians alike.

Popliteal fossa block: Lateral approach to the sciatic nerve

Regional anesthesia for foot and ankle surgery in children is usually provided using a caudal blockade. However, there are certain conditions that preclude the use of a caudal block. The use of a sciatic nerve block in addition to a femoral nerve block can provide good analgesia for these procedures. In a sedated or anesthetized child, it may be easier to perform this nerve block with the patient in a supine position. The use of a nerve stimulator and a sheathed needle can assist in locating the nerve. This nerve block may offer the additional advantage of a longer duration of pain relief. Copyright 2002, Elsevier Science (USA). All rights reserved.

Room B, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Neostigmine Does Not Prolong the Duration of Analgesia after Popliteal Fossa Block with Mepivacaine

Room B, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Neostigmine Does Not Prolong the Duration of Analgesia after Popliteal Fossa Block with Mepivacaine

Pediatric Regional Anesthesia: Beyond the Caudal

Pediatric Regional Anesthesia: Beyond the Caudal