Popliteal Sciatic Nerve Research Articles

Comparing Sciatic Nerve Block in Novel Convenient Supine Position Via Medial Approach Versus Lateral Position Via Lateral Approach

Introduction: Popliteal sciatic nerve block performed in lateral position usually requires a change in position for the patient. This is time consuming and may cause discomfort to the patient. Methods: This prospective study compared patients' preference and peri-operative outcomes in supine position via medial approach to the sciatic nerve and lateral position via lateral approach to the nerve. Prospective registration of this study with NHG Human Research Protection Programme was on 9 Sept 2021. Institutional review board approval was obtained for this study on 20 May 2022. All research participants provided written informed consent with the first patient enrolled on 05 June 2022. 50 patients from Ng Teng Fong General hospital (NTFGH) who were undergoing popliteal sciatic nerve block with or without sedation were recruited for the study and randomised to either receive the block in supine or lateral position. Results: This study showed that there were significantly more patients in the supine group preferring to be in supine position during the block with p-valve <0.001. 45.8% of patients who had the block performed in lateral position preferred supine position instead. There was no significant difference in the peri-operative outcomes or duration taken for block completion. Most patients preferred to be in the supine position for popliteal sciatic nerve block as it was more comfortable. Conclusion: Performing the block in supine position increased patient’s comfort significantly and is non-inferior to performing it in lateral position in terms of safety, efficacy and efficiency profile.

Surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block in fixation of trimalleolar fracture

Introduction: Combined popliteal sciatic nerve and adductor canal block under ultrasound guidance has been described as a safe and effective mean of regional anesthesia for foot and ankle surgery. Limited studies have shown its effectiveness while performed by surgeons. This study aims to assess the effectiveness and safety for this mode of regional anesthesia while carried out by orthopedic surgeons. Method: Patients presented to our unit with trimalleolar fracture of ankle who underwent operation under surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block were evaluated in this study. A total of 13 patients with mean age of 57.8 were included. Data regarding the diagnosis, pattern of injuries, comorbidities in American Society of Anesthesiologists Classification, duration of operation, blood loss, intraoperative pain control in visual analog scale (VAS), degree of motor blockage, postoperative pain control and hospital length of stay were collected and evaluated. Result: All patients experienced complete anesthesia with VAS 0 and complete motor blockage throughout the operation. Average operative time was 179 min. Postoperative pain control was satisfactory. There was no regional anesthesia related complication arise. Conclusion: Surgeon-administered ultrasound-guided combined popliteal sciatic nerve and adductor canal block is a safe and effective mean to provide anesthesia for trimalleolar fracture fixation according to our experience.

Comparison of the Analgesic Duration Using Ultrasound-guided Popliteal Sciatic Nerve Block between Diabetics with Neuropathy and Nondiabetics without Neuropathy.

In India, the prevalence of diabetes mellitus neuropathy was reported to be as high as 30%. Eight percentage of the diabetic population suffer from foot ulceration and 1.8% have amputations. Popliteal nerve block can be potentially used for foot and ankle surgery with several advantages. To compare analgesic duration of an ultrasound (US)-guided popliteal sciatic nerve block between diabetics with neuropathy and nondiabetics without neuropathy. Participants were allocated into two groups for popliteal sciatic nerve blocks under US guidance. The primary outcome was the duration to onset of sensory and motor blockade. The secondary outcome was the duration to rescue analgesic and the visual analog scale scoring within 24 h. Hemodynamic outcomes were also monitored along with the above variables. It was observed that the onset of sensory blockade was faster in participants with diabetes mellitus with peripheral neuropathy as compared to the nondiabetic participants and the duration for onset of motor blockade in dorsiflexion was faster in diabetic patients as compared to the nondiabetic patients (17.48 ± 3.21 min). However, there was no significant changes when comparing the onset of duration to loss of plantar flexion, in diabetics (17.86 ± 2.29 min) versus in nondiabetics (18.51 ± 3.32 min). The duration for rescue analgesics was found to be longer in diabetic participants (13.19 ± 2.14 h) as compared to the nondiabetic participants (11.44 ± 1.86 h). No differences were observed in the hemodynamic changes and the complications associated with local anesthetics in either group. Diabetic patients with neuropathy have faster onset of blockade when compared to nondiabetic patients without neuropathy which may be due to the degenerative condition of the peripheral nerves in them. The hemodynamic parameters do not play a role in defining the outcome of the block.

Dexamethasone as a perineural adjuvant to a ropivacaine popliteal sciatic nerve block for pediatric foot surgery: a randomized, double-blind, placebo-controlled trial

BackgroundThis study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte...

Plantar Compartment Block Improves Enhanced Recovery after Hallux Valgus Surgery: A Randomized, Comparative, Double-blind Study.

Walking ability is a key factor in enhanced recovery after foot ambulatory surgery. Plantar compartment block offers an analgesic alternative to popliteal sciatic nerve block (PSNB) for hallux valgus surgery. The objective of this study was to compare these two regional anesthesia strategies on patients' ability to recover a painless unaided walk. This prospective double-blinded (patient; observing anesthesiologist) randomized study compared patients scheduled for hallux valgus surgery receiving PSNB with 1% mepivacaine, then combined plantar and peroneal nerve blocks (plantar compartment block [PCB] group) with ropivacaine 0.5% and dexamethasone, or PSNB with ropivacaine 0.5% and dexamethasone (control group). The primary outcome was the patient's ability to walk unaided 6 h after PSNB. The test was performed on a GAITRite, spatio-temporal gait analysis mat. For 3 days, the number of patient steps, pain levels, rescue analgesics, patient's experience, and adverse events were assessed. Sixty patients were included and 59 were analyzed. The number of patients walking unaided on the GAITRite mat was significantly higher in the PCB group (21 of 30, 70%) than in the control group (4 of 29, 13.8%; P < 0.001). Gait quality using the Functional Ambulation Profile score was 63 ± 13.6 in the PCB group and 49.5 ± 4.7 in the control group (P < 0.001). Median time to free ambulation at home was significantly lower in the PCB group (9 h [8.2 to 11.8]) than in the control group (33.5 h [24 to 47]; P < 0.001). Postoperative pain did not differ between the groups (β = -0.41 [-1.78 to 0.95]; P = 0.548). The number of steps on day 3, the time of first rescue analgesic, the number of patients using rescue analgesia, consumption of morphine, and patient's experience did not differ between the groups. PCB decreased the time to return to unaided walking, with improved gait, compared with PSNB, improving effective analgesia and low consumption of rescue analgesics. This innovative regional anesthesia strategy enhanced recovery after surgery.

Comparing Different Multimodal Analgesia Protocols for Primary Total Knee Arthroplasty-A Retrospective Cohort Analysis.

Background: Several local regional anesthesia regimes have been described in the literature to reduce post-surgical pain following total knee arthroplasty (TKA), but it is unclear which regime has the best analgetic effect combined with the best motor function. The aim of this study was to determine if patients with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) combined with an adductor canal block (SACB) had less pain, better motor function, and less opioid consumption after TKA than patients with a femoral nerve block (FNB) combined with a popliteal sciatic nerve block (PSB). Methods: In a retrospective cohort analysis, 342 patients following primary TKA were examined; 175 patients were treated with an IPACK combined with a SACB, and 167 patients with a femoral FNB combined with a PSB. The outcome parameters postoperative pain (visual analogue scale (VAS) for mobilization and at rest, functional recovery, opioid consumption, hospital discharge, and complications were analyzed and compared between both groups. Results: The IPACK/SACB group had a higher postoperative need for opioids despite higher doses of ropivacaine compared to the FNB/PSB group, accompanied by higher VAS scores. Patients' satisfaction was equal between the groups. Both groups showed comparable mobilization rates and walking distances following TKA. Conclusions: IPACK/SACB showed equal results compared to FNB/PSB for mobilization rates and patients' satisfaction following TKA without a reduction in opioid consumption.

The application of surgeon-administered ultrasound-guided popliteal sciatic nerve block in foot and ankle injuries

Introduction Ultrasound-guided popliteal sciatic nerve block has been described as a safe and consistent form of regional anesthesia for foot and ankle surgery. Little studies have been performed to prove the effectiveness of surgeon self-administered regional anesthesia for foot and ankle injury requiring an operation. This study aimed to assess the applicability and safety in surgeon-administered ultrasound-guided popliteal sciatic nerve block in providing anesthesia for foot and ankle fracture. Material and Methods Patients with foot and ankle injury who underwent operation under surgeon-administered ultrasound-guided popliteal sciatic nerve block were evaluated in this retrospective study. A total of 7 patients (3 females and 4 males) with a mean age of 46) were evaluated by the diagnosis, side of injury, comorbidities in American Society of Anesthesiologists Classification (ASA), duration of operation, blood loss, pain control in visual analog scale (VAS) intra-operatively, degree of motor blockage, post-operative pain control and hospital length of stay. Result Average age of the study population was 46. Of all the patients, two of them were of ASA I four of them were of ASA II and one of them was of ASA III. Complete sensory and motor blockages were achieved for all patients. Average operative time was 117 min. Average blood loss was 16.4 mL. Average post-operative inpatient stay was 3.57 days. There was no regional anesthesia-related complication arising from the procedure. Conclusion Surgeon-administered popliteal sciatic nerve block is a safe procedure and can provide excellent pain control throughout the operation according to our experience. Foot and ankle fracture fixation can be performed by orthopedic surgeons under this technique.

Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance.

Background: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance Imaging (MRI). Methods: A descriptive, observational, cross-sectional study was performed on 126 knee MRIs. The variables studied were age, sex, and distance between different neurovascular structures of the popliteal fossa (tibial nerve, common peroneal nerve, and vascular bundle). Data were analyzed for normality (Kolmogorov-Smirnov) and variance homogeneity (Levène). A value of p < 0.05 and a confidence interval of 9% were considered statistically significant for all comparisons. Student's t-test was used to compare the means between independent samples. Results: We observed statistically significant differences between the sexes regarding EP-EPS (external plateau-external popliteal sciatic nerve (common peroneal)), EP-IPS (external plateau-internal popliteal sciatic nerve (tibial)), and IP-PA (internal plateau-popliteal artery) measurements. The average distance between both nerves, EPS-IPS (external popliteal sciatic nerve and internal popliteal sciatic nerve), was 25.96 mm in females, while the value obtained in males was 29.93 mm, but this difference was not statistically significant. Conclusions: The average distance from the posterior capsule to the EPS and IPS nerves is greater in males than in females, despite no statistical differences. The presence of a lateralized arteriovenous bundle reduces the infiltration area of the external compartment. Regarding the safety area, infiltration of the internal compartment is safe since the volume diffuses into the muscle mass of the internal gastrocnemius upon injection. To infiltrate the external compartment, the needle must move at least 2 cm from the midline toward the external side (to exceed the maximum displacement of the neurovascular bundle established at 1.82 cm), and not advance beyond 0.76 cm (minimum distance at which we located the common peroneal nerve in the external compartment).

The effectiveness of ambulatory continuous popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia in patients undergoing foot or ankle surgery (CAREFREE trial); a randomized, open label, non-inferiority trial

Study objectiveManagement of pain after foot and ankle surgery remains a concern for patients and healthcare professionals. This study determined the effectiveness of ambulatory continuous popliteal sciatic nerve blockade, compared to standard of care, on overall benefit of analgesia score (OBAS) in patients undergoing foot or ankle surgery. We hypothesized that usage of ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care. DesignSingle center, randomized, non-inferiority trial. SettingTertiary hospital in the Netherlands. PatientsPatients were enrolled if ≥18 years and scheduled for elective inpatient foot or ankle surgery. InterventionPatients were randomized to ambulatory continuous popliteal sciatic nerve blockade or standard of care. MeasurementsThe primary outcome was the difference in OBAS, which includes pain, side effects of analgesics, and patient satisfaction, measured daily from the first to the third day after surgery. A non-inferiority margin of 2 was set as the upper limit for the 90% confidence interval of the difference in OBAS score. Mixed-effects modeling was employed to analyze differences in OBAS scores over time. Secondary outcome was the difference in opioid consumption. Main resultsPatients were randomized to standard of care (n = 22), or ambulatory continuous popliteal sciatic nerve blockade (n = 22). Analyzing the first three postoperative days, the OBAS was significantly lower over time in the ambulatory continuous popliteal sciatic nerve blockade group compared to standard of care, demonstrating non-inferiority (−1.9 points, 90% CI -3.1 to −0.7). During the first five postoperative days, patients with ambulatory continuous popliteal sciatic nerve blockade consumed significantly fewer opioids over time compared to standard of care (−8.7 oral morphine milligram equivalents; 95% CI -16.1 to −1.4). ConclusionsAmbulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care with single shot popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia.

Rehabilitation management of postmenopausal osteoporosis associated with degenerative neurological conditions

Abstract: Background: The evolving association of neurological disorders such as Parkinson's disease (PD) and stroke may aggravate postmenopausal osteoporosis. In this situation, inactivity and lack of movement are the main factors that contribute contribute to exacerbate osteoporosis and the occurrence of osteoporotic fractures. Material and Methods: We present the case of a 62-year-old female patient diagnosed with diffuse postmenopausal osteoporosis, Parkinson's dis-ease, and left frontal ischemic lacuna. 6 months before admission to our rehabilitation clinic, she suffered a trauma by falling that resulted in an L3 vertebral fracture and a right forearm fracture. L2-L4 posterior segmental spinal fusion and right forearm osteosynthesis were performed. Post-operatively, a motor deficit was found in the lower limbs. She was diagnosed clinically and fol-lowing neurophysiological investigations with bilateral external popliteal sciatic nerve paresis. In these circumstances, the patient suffered a new trauma, resulting in an open fracture at the same level of the right forearm which also required surgical treatment. Results and discussion: Following the rehabilitation program, the evolution was favorable with improved functioning and partial restoration of walking. Conclusion: The association of degenerative neurological and bone meta-bolic diseases in this case led to significant disability, making the rehabilitation process more challenging.

Intravenous injection of dexamethasone is non-inferior to perineural administration for popliteal sciatic nerve and saphenous nerve blocks: A randomized, controlled, triple-blind study

BackgroundThe aim of this study was to assess whether intravenous dexamethasone was noninferior to perineural dexamethasone as an adjuvant to ropivacaine for a combination of saphenous and sciatic nerve blocks in patients undergoing foot and ankle surgery. MethodsThis was a prospective, blinded, randomized noninferiority study. Seventy-five patients, aged 18–75 years, with an American Society of Anesthesiologists (ASA) physical status I-III who underwent foot and ankle surgery were involved. Patients scheduled for ultrasound-guided popliteal sciatic nerve block and saphenous nerve block were randomized to receive 0.375% ropivacaine with 7.5 mg of dexamethasone perineurally (Dex-PN), 10 mg of dexamethasone intravenously (Dex-IV) or neither (Placebo). The primary outcome was the duration of analgesia. The major secondary outcomes were the composite pain intensity and opioid consumption score at 0–48 h intervals after anesthesia. ResultsThe mean analgesic duration was 26.2 h in the Dex-IV group and 27.9 h in the Dex-PN group (duration difference, −1.7; 95% CI, −3.8 to 0.43; P = 0.117), and both durations were significantly longer than that in the placebo group (17.6 h, P < 0.001). Conditions for establishing non-inferiority were met. ConclusionsOur findings indicate that a single 10-mg intravenous dose of dexamethasone was noninferior to the combined dose of ropivacaine plus deaxmethasone in terms of duration of analgesia for foot and ankle surgery.

Plantar compartment block for hallux valgus surgery: a proof-of-concept anatomic and clinical study

BackgroundHallux valgus surgery is associated with moderate to severe postoperative pain. We hypothesized that a plantar compartment block may be a good technique for postoperative analgesia. We describe an anatomic...

Comparative Efficacy of iPACK vs Popliteal Sciatic Nerve Block for Pain Management Following Total Knee Arthroplasty: A Retrospective Analysis.

Introduction Total knee arthroplasty (TKA) is associated with severe acute postoperative pain. The use of tourniquets and drains (T/D) is common in TKA but may have an influence on postoperative pain and muscular strength. The infiltration of local anesthetic between the popliteal artery and capsule of the knee (iPACK block) is a motor-sparing block that provides analgesia to the posterior aspect of the knee. However, evidence regarding its efficacy is scarce.This study aims to assess the effectiveness of iPACK block and the impact of T/D use on pain and muscular strength after TKA. Material and methods A retrospective study was carried out including patients who underwent TKA from January 2020 to April 2023. Patients were allocated into groups according to the peripheral nerve block performed and T/D use. Results We included 415 patients in this study. No differences were found in pain at rest or the need for rescue analgesia between patients who received an iPACK block or sciatic nerve block (SNB) with T/D applied. Patients who received a SNB reported lower pain scores on movement (p= 0.019), but with a higher prevalence of motor block (p < 0.001). Patients who underwent surgery without using T/D reported lower pain scores on movement (p= 0.021) and reduced need for rescue analgesia (p= 0.041). Conclusion These findings indicate that iPACK block can facilitate early mobilization after TKA without significant impact on postoperative muscle strength. Furthermore, the use of a T/D may be a source of postoperative pain that could compromise early rehabilitation.

Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study.

Ultrasound popliteal sciatic nerve block (UPSNB) is commonly performed in foot and ankle surgery. This study aims to assess the use of dexmedetomidine and dexamethasone as adjuvants in UPSNB for hallux valgus (HV) surgery, comparing their efficacy in producing motor and sensory block and controlling postoperative pain. The adverse event rate was also evaluated. This mono-centric retrospective study included 62 adult patients undergoing HV surgery: 30 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg and dexamethasone 4 mg (Group 1), whereas 32 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg, and dexmedetomidine 1 mcg/Kg (Group 2). At first, the visual analogue scale (VAS) was evaluated after 48 hours. The other outcomes were time to motor block regression, evaluation of the first analgesic drug intake, analgesic effect, adverse effects (hemodynamic disorders, postoperative nausea and vomiting (PONV)) and patient satisfaction. The continuous data were analyzed with student's t-test and the continuous one with χ2. Statistical significance was set at a p-value lower than 0.05. No significant difference was found in VAS after 48 hours (4.5 ± 1.6 vs 4.7 ± 1.7, p = 0.621) to motor block regression (18.9 ± 6.0 vs 18.7 ± 6, p = 0.922). The number of patients that took their first analgesic drug in the first 48 h (p = 0.947 at 6 hours; p = 0.421 at 12 hours; p = 0.122 at 24 hours and p = 0.333 at 48 hours) were not significant. A low and similar incidence of intraoperative hemodynamic disorders was recorded in both groups (hypotension p = 0.593; bradycardia p = 0.881). Neither PONV nor other complication was found. Patients in Group 1 reported a lower degree of interference with sleep (p = 0.001), less interference with daily activities (P = 0.002) and with the affective sphere (P = 0.015) along with a more satisfactory postoperative pain management (p < 0.001) as compared to Group 2. No significant differences were observed in the duration of motor and sensory blockade between patients in both groups. Additionally, both groups showed good pain control with a low rate of adverse effects, even if there was no clinical difference between the groups. However, patients who received dexamethasone reported experiencing less interference with their sleep, daily activities and overall emotional well-being, and overall pain control.

Comparison of continuous popliteal nerve blocks using lidocaine vs. bupivacaine infusions for ambulatory foot surgery: a randomized, double-blind, noninferiority trial

Background and objectivesContinuous sciatic popliteal nerve block effectively manages pain after ankle and foot surgery. Most studies on continuous infusion of local anesthetics by perineural catheters have been made with bupivacaine, levobupivacaine, and ropivacaine, but lidocaine has not been used. The main objective of this study was to compare the quality of analgesia, motor function, and side effects between lidocaine and bupivacaine infusions in bilateral continuous popliteal nerve blocks for foot surgery.MethodsThis was a prospective, double-blind, randomized, parallel-group, noninferiority study. We enrolled 70 patients undergoing bilateral foot or ankle surgery that could be performed under general anesthesia and continuous regional analgesia using sciatic popliteal nerve blocks. During their postoperative care, they were randomized into 2 groups: group lidocaine (lidocaine 0.5%, 5 ml/h) or group bupivacaine (bupivacaine 0.1%, 5 ml/h), administered through elastomeric pumps. The primary outcome was pain at 24 h after surgery, assessed by a verbal numeric rating scale (ranging from 0 to 10). A pre-specified non-inferiority margin of 1.5 was defined. Secondary outcomes were the degree of motor and sensitive block, total opioid use, and difficulties with pump or catheter management.ResultsThe mean postoperative pain at 24 h of surgery was 2.06 (95% bootstrap confidence interval bCI 1.29, 2.83) and 1.82 (95% bCI 1.02, 2.62) in the lidocaine and bupivacaine group, respectively. The upper limit of the 95% bCI for the mean difference between lidocaine and bupivacaine was 0.82, declaring non-inferiority. No differences in the postoperative rescue analgesia use and satisfaction with care were found. No differences in postoperative NRS, sensory block and motor block were seen between groups.ConclusionsLidocaine 0.5% and bupivacaine 0.1% provide similar postoperative analgesia through a sciatic popliteal catheter in ambulatory bilateral foot surgery patients.Clinical Trial Registrationhttps://clinicaltrials.gov/, identifier: NCT02121119

Distal subsartorial compartment block of the saphenous nerve - A dissection study and a patient case series

Study objectiveA saphenous nerve block is an important tool for analgesia after foot and ankle surgery. The conventional midthigh approach to saphenous nerve block in the femoral triangle may impede ambulation by impairing quadriceps motor function. Primary objective: Developing a selective saphenous nerve block targeting the nerve distal to its emergence from the adductor canal in the subsartorial compartment. DesignThis study consists of A) a dissection study and B) Data from a clinical case series. SettingA) Medical University of Innsbruck, Austria (dissection of 15 cadaver sides) and.B) Aarhus University Hospital, Denmark (5 patients). InterventionsA) Five mL of methylene blue was injected into the subsartorial compartment distal to the intersection of the saphenous nerve and the tendon of the adductor magnus guided by ultrasound. B) Five patients undergoing major hindfoot and ankle surgery had a subsartorial compartment block with 10 mL of local anesthetic in addition to a popliteal sciatic nerve block. MeasurementA) The frequencies of staining the saphenous and medial vastus nerves. B) Assessment of postoperative pain by NRS score (0−10) and success rate of saphenous nerve block by presence of cutaneous anesthesia in the anteromedial lower leg, and motor impairment by ability to ambulate. Main resultsA) The saphenous nerve was stained in 15/15 cadaver sides. A terminal branch of the medial vastus nerve was stained in 2/15 cadaver sides. B) All patients were fully able to ambulate without support. No patients had any post-surgical pain from the anteromedial aspect of the ankle and foot (NRS score 0). The success rate of saphenous nerve block was 100%. ConclusionThe saphenous nerve can be targeted in the subsartorial compartment distal to the intersection of the nerve and the tendon of the adductor magnus. The subsartorial compartment block provided efficient analgesia without quadriceps motor impairment.

Evaluation of age-based local anaesthetic dosing of bupivacaine for popliteal sciatic nerve block in children undergoing foot and ankle surgery: A prospective single arm interventional study.

Recommendations on paediatric single-injection local anaesthetic (LA) dosing for peripheral nerve blocks (PNBs) are based on the children's weight and limited by weight-based toxicity concerns. In this study, we assessed the extent of circumferential spread and block characteristics following the injection of an age-based volume (age in years = LA volume) of 0.25% bupivacaine following popliteal sciatic nerve block (PSNB). Thirty children aged between 2 and 12 years with the American Society of Anesthesiologists (ASA) physical status I and II and undergoing foot and ankle surgical procedures were given single-injection ultrasound-guided subparaneural PSNB using 0.25% bupivacaine at age-based LA volume after the administration of anaesthesia. The circumferential pattern of LA spread (primary objective) was assessed along the nerve (both cephalad and caudal) using ultrasound from the point of administration and the block characteristics in terms of duration of sensory block. The mean [standard deviation (SD)] cephalic circumferential LA spread distance was 2.52 (0.68) [95% confidence interval (CI): 2.27-2.76] cm. The mean (SD) caudal circumferential LA spread distance was 2.27 (0.48) [95% CI: 2.09-2.44] cm. The mean (SD) duration of the sensory block was 9.03 (0.97) [95% CI: 8.67-9.38] h. The age-based LA volume of bupivacaine for ultrasound-guided PSNB resulted in a longitudinal circumferential spread of around 4.7 cm (adding both cephalic and caudal spread) and provided adequate analgesia for nine postoperative hours.

Tibialis Posterior Tendon Transfer for Foot Drop: Case Report

Irreparable sciatic nerve palsy is a cause of foot drop and resulting in absent or weak most of the muscles in leg. There may be dysfunctions of all tendons in the leg excepting Achilles tendon and plantaris tendon. The treatment of this atypical neurologic injury has not been defined. I reported a case of foot drop case of patient who presented with paralysis of the external popliteal sciatic nerve, The neurological exam revealed a deficit of the dorso flexion of the foot and hypoesthesia of the dorsal region of the foot concomitant with a section of the external popliteal sciatic nerve. tibialis posterior transfer gives good results in terms of normal gait, high patients, satisfaction with minimal donor site morbidity and low complication rate.

A CLINICAL COMPARATIVE STUDY OF ULTRASOUND-GUIDED POPLITEAL NERVE BLOCK WITH 0.5% BUPIVACAINE HYDROCHLORIDE WITH AND WITHOUT 8MG DEXAMETHASONE FOR KNEE SURGERIES

Objective: This study aimed to see how adding dexamethasone 8 mg to 0.5% bupivacaine affected the length of sensory and motor blockage of the popliteal sciatic nerve in ankle and foot surgeries.&#x0D; Methods: This prospective randomized clinical comparison trial enrolled 60 patients with American Society of Anesthesiologists (ASA) physical status grades III and IV, aged 50-80 y, scheduled for ankle and foot procedures from March 2023 to July 2023. Patients were assigned into two groups of 30 at random. 28 ml of 0.5% bupivacaine and 8 mg dexamethasone were given to Group D. Group N was given 28 ml of o.5% bupivacaine and 2 ml of NS. Here, 20 ml was used for sciatic nerve block and 10 ml for saphenous nerve block.&#x0D; Results: The mean onset of sensory block in group D was 23.2±6.8 min, while 21.7±6.9 min in group N (p 0.3999). This was not statistically significant. The onset of motor block was 22.9±7.9 in group D and 22.3±7.1 in group N, which were statistically insignificant (p 0.7581). The duration of the motor block in group D was 11.3±3.2 h, whereas it was 5.9±2.3 h in group N (p 0.0001), which was statistically significant. The length of the sensory block in group D was 14.9±3.8 h, while it was 8.3±3.4 h in group N (p 0.0001), which was also statistically significant. The VAS score in group N was significantly higher than in group D; it began 3 h after surgery and remained at 4 h, 5 h, 6 h, 8 h, 10 h, and 12 h. All 30 patients in Group N required their first rescue analgesia during the first 12 h postoperatively. In contrast, only 12 patients (40%) required their first analgesia within the first 12 h, and 18 (60%) requested their first analgesia within the second 12 h.&#x0D; Conclusion: Adding 8 mg dexamethasone to 0.5% Bupivacaine hydrochloride in ultrasound-guided popliteal and saphenous nerve blocks for ankle and foot procedures extends postoperative sensory and motor block duration.

Quantitative assessment of ultrasound-guided sciatic nerve block - A comparison of a single-point versus two-point injection technique: A randomised controlled, double-blinded trial.

Sciatic nerve block at the popliteal level for lower limb procedures provides unpredictable success rates even with ultrasonographic (USG) guidance. This study aimed to compare USG-guided single-point versus two-point injection techniques. Sixty patients posted for foot surgeries under USG-guided sciatic nerve block were randomised into Group Single Point, receiving a single injection of 20 mL of 1.5% lignocaine with adrenaline just proximal to the sciatic nerve bifurcation, and Group Double Point, receiving two injections of 10 mL of 1.5% lignocaine with adrenaline, one at the point similar to the first group and a second injection 6 cm above the first point. Sensory blockade onset, time to complete sensory blockade, time to complete motor blockade, length of the nerve exposed and analgesia duration were evaluated. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 20 software. Double-point injection technique showed a significantly faster time to complete motor blockade [14.46 (9.93) min], increased length of nerve exposed to local anaesthetic [23.23 (7.209) cm] and extended duration of analgesia [420.40 (99.34) min] compared to the single-point injection technique [20.89 (12.62) min, 18.78 (5.95) cm and 344.28 (125.97) min, respectively]. The onset of sensory blockade and the time to complete sensory blockade were comparable between the two groups. USG-guided popliteal sciatic nerve block with a double-point injection technique does not significantly shorten the time to complete the sensory block. However, the time to complete motor nerve block and duration of analgesia are prolonged significantly, which may be clinically beneficial for postoperative analgesia.