Sciatic Nerve Block Research Articles

Effectiveness of Popliteal Nerve Block in below Knee Surgeries

Aim: To observe the effectiveness of sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia in local population Study design: Descriptive cross-sectional study Place and duration of study: Department of Anesthesia, The Indus Hospital, Karachi from 11th March 2013 to 15th March 2014. Methodology: One hundred and fourteen patients with elective operations like wound debridement of foot, amputation of toes were included. After 15 minutes of giving the block, and at the time of incision, the patient was asked about his/her pain level by showing the pain scale. If the patient points at level 0, the surgery was proceed and the block was termed as effective. Results: Most of the patients were between 51-70 years of age and mean age was 58.83±9.21 years. There were 73(64.04%) males and 41(35.96%) females. Seventy four (64.91%) were in ASA-III, 32(28.07%) were in ASAIV and 8(7.02%) were in ASAV. The pain was not reported in 103(90.35%) patients while 11(9.6%) had pain in which 4 patients had mild pain, 5 moderate and 2 had severe pain. Block was effective in 103(90.35%) cases and ineffective in 11(9.65%) cases. Conclusion: Sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia be taken as an anaesthesia method for surgeries below the knee as well as for the control of the post-operative pain specifically in patients where spinal anaesthesia is not favorable Keywords: Below knee surgery, Sciatic nerve block, Popliteal nerve block

Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial.

Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess whether an incidental finding of two patients with an extension of the sciatic nerve block beyond 24 h following 100 mg of intramuscular tramadol administration could be confirmed. Thirty-seven patients scheduled for a calcaneal intramedullary fixation (Calcanail®) were randomly divided into two groups. The tramadol group (n = 19) received a sciatic nerve block with 20 mL of 0.25% bupivacaine and a concomitant dose of 100 mg of intramuscular tramadol, while the control group (n = 18) received an identical sciatic nerve block with concomitant injection of normal saline (placebo). All patients had a spinal anesthesia with light sedation for the procedure. The time to first analgesic request defined as appearance of any pain (NRS > 0) was assessed as the primary endpoint with a clinically relevant expected result of at least 50% elongation in sensory blockade. The median time to first analgesic request from time of blockade in the tramadol group was 670 min compared with 578 min in the control group. The result was clinically not relevant and statistically not significant (p = 0.17). No statistical difference could be demonstrated in the time to first opioid request, although a trend for opioid sparing in the tramadol group could be seen. Total morphine consumption in the first 24 h was also statistically insignificant (the tramadol group 0.066 mg kg-1 compared with 0.125 mg kg-1 in the control group). In conclusion, intramuscular tramadol does not extend the duration of analgesia of a sciatic nerve block following a calcaneal fracture fixation beyond 2 h and an opioid sparing effect could not be demonstrated in this trial.

Femoral Nerve Block and Local Instillation Analgesia Associated With More Reliable Efficacy in Regional Anesthesia Interventions Within 24 Hours Following Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

To assess the relative effectiveness of different regional anesthetic techniques (peripheral nerve blocks, local instillation analgesia, including intra-articular, subcutaneous, and periarticular infiltration) in patients undergoing anterior cruciate ligament reconstruction (ACLR). PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to December 31, 2020. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants after ACLR that compared regional anesthesia interventions were selected. The 2 coprimary outcomes were (1) rest pain scores and (2) cumulative oral morphine equivalent consumption on day 1 (24 hours) post-ACLR. Data were pooled using a Bayesian framework. Of 759 records identified, 46 trials were eligible, evaluating 9 interventions in 3,171 patients. Local instillation analgesia (LIA), including intra-articular, subcutaneous, and periarticular infiltration, had significant improvement in pain relief as compared with placebo (-0.91; 95% CrI -1.45 to -0.37). Femoral nerve block (FNB) also showed significant effects in relieving pain as compared with placebo (-0.70; 95% 95% credible interval [CrI] -1.28 to -0.12). Compared with placebo, a significant reduction in opioid consumption was found in LIA (mean difference -13.29 mg; 95% CrI -21.77 to -4.91) and FNB (mean difference -13.97 mg; 95% CrI -24.71 to -3.04). Femoral and sciatic nerve block showed the greatest ranking for pain relief and opioid consumption without significant evidence (P > .05) to support superiority in comparison with placebo, respectively. Our meta-analysis shows that FNB and LIA can significantly diminish postoperative pain and reduce opioid consumption following ACLR compared with placebo in the setting of regional anesthesia, and femoral and sciatic nerve block may be the number 1 top-ranked analgesic technique despite high uncertainty. I, Systematic review of Level I studies.

Evaluation of urine specific gravity as a predictor of hypotension during anaesthesia in healthy dogs premedicated with dexmedetomidine

ObjectiveTo investigate the relationship between urine specific gravity (USG) and the risk of arterial hypotension during general anaesthesia (GA) in healthy dogs premedicated with dexmedetomidine and methadone. Study designProspective clinical cohort study. AnimalsA total of 75 healthy client-owned dogs undergoing GA for elective tibial plateau levelling osteotomy. MethodsAfter placing an intravenous catheter, dogs were premedicated with dexmedetomidine (5 μg kg–1) and methadone (0.3 mg kg–1) intravenously. After induction of GA with alfaxalone to effect, the bladder was expressed and USG measured. An arterial catheter was placed, and residual blood was used to measure packed cell volume (PCV) and total protein (TP). GA was maintained with isoflurane vaporised in oxygen and a femoral and sciatic nerve block were performed. Arterial blood pressure < 60 mmHg was defined as hypotension and recorded by the anaesthetist. Treatment for hypotension was performed in a stepwise manner following a flow chart. Frequency of hypotension, treatment and response to treatment were recorded. Logistic regression modelling was used to assess the association between USG, TP and PCV and incidence of perioperative hypotension; p < 0.05. ResultsData from 14 dogs were excluded. Of the 61 dogs, 16 (26%) were hypotensive during GA, 15 dogs needed treatment of which 12 were responsive to a decrease in inhalant vaporiser setting. The logistic regression model was not statistically significant (p = 0.8). There was no significant association between USG (p = 0.6), TP (p = 0.4), PCV (p = 0.8) and arterial hypotension during GA. Conclusions and clinical relevanceIn healthy dogs premedicated with dexmedetomidine and methadone and maintained under GA with isoflurane and a femoral and sciatic nerve block, there was no relationship between the specific gravity of urine collected after premedication and intraoperative arterial hypotension.

Evaluation of a constant rate intravenous infusion of dexmedetomidine on the duration of a femoral and sciatic nerve block using lidocaine in dogs.

This study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Client-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005-0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t-test and a Kaplan-Meier test (p < 0.05). Twenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer (p < 0.001) for group D [168 (146-191, 95% CI), 161 (143-179, 95% CI) min] than in group C [120 (96.1-144, 95% CI), 116 (90.9-142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different (p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C. Dexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours.

The use of granisetron on bupivacaine induced sciatic nerve block in rats

Purpose The effects of the 5-hydroxytryptamine (5-HT3) receptor antagonists on regional anaesthesia are complex and unclear. The present study was designed to test the hypothesis that granisetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor block, sensory block, and proprioception in a dose-dependent fashion in a rat model of bupivacaine-induced sciatic nerve blockade. Materials and methods Thirty-eight male Wistar Albino rats that received unilateral sciatic nerve blocks were randomly divided into five experimental groups. Group B received a perineural of 0.3 ml of bupivacaine alone; Group BG800 received perineural 0.3 ml of bupivacaine and 800 µg of granisetron 10 min later; Group BG1200 received perineural 0.3 ml of bupivacaine and 1200 µg of granisetron 10 min later; Group BG1200IP received a perineural 0.3 ml of bupivacaine and an intraperitoneal injection of 1200 µg of granisetron 10 min later; and Group S was sham operated. A blinded investigator assessed motor, sensory and proprioception function every 10 min until the return of normal function. Results The medians for recovery times in Group B, Group BG800, Group BG1200, and Group BG1200IP were 105, 64, 85, and 120 min for motor function, respectively; 80, 64, 84, and 104 min for sensory function; 80, 63, 85, and 108 min were calculated for the proprioception function. The time to the return of normal motor, sensory, and proprioception function was not statistically significantly different between the groups (p > 0.05). Motor block did not develop in any of the rats in Group S. Conclusions Local and systemic application of granisetron was not significantly decrease the duration of bupivacaine induced motor, sensory, and proprioception block of sciatic nerve in rat.

Comparison of Ultrasound-Guided Anterior and Posterior Approaches to Sciatic Nerve Block for Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Sciatic nerve block is used for anaesthesia and analgesia in lower limb surgeries. The anterior approach to the sciatic nerve is rarely performed due to unreliable anatomical surface markings. Aim: To compare the anterior and posterior approaches to sciatic nerve block in terms of patient comfort and technical difficulty. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. A total of 84 patients who underwent lower limb surgeries from November 2020 to August 2022 were included. Informed consent was obtained, and patients were randomised into two groups-Group-A and Group-P-using the card method. Ultrasound-guided sciatic nerve block was performed using the anterior approach in Group-A and the posterior approach in Group-P. Sensory and motor blockade, time to perform the block, number of attempts, duration of analgesia, and patient satisfaction were recorded. Statistical analysis was performed using the Chi-square test, Analysis of Variance (ANOVA), student t-test, and the results were represented in tables. Results: The median age in Group-A was 42.95±12.69 years, and in Group-P was 43.95±8.68 years. Males were higher in number with 26 (31%) in Group-A and 23 (27%) in Group-P, respectively. Patient satisfaction, duration of analgesia (10.3±3.5 years Group-P and 10.5±4.0 years Group-A), onset of sensory (11.85±7.35 years Group-P and 9.53±5.40 years Group-A), and motor blockade (18.67±7.05 years Group-P years and 17.82±5.70 years Group-A) were similar in both groups. The number of attempts (2.85±0.90 years Group-P and 3.05±0.91 years Group-A) and time taken for performing the sciatic nerve block (6.75±1.10 years Group-P and 7.44±1.00 years Group-A) was higher in the anterior approach compared to the posterior approach. Conclusion: Although both approaches to sciatic nerve block are equally effective, this study concludes that the posterior approach is simpler to perform, requires less time, and provides better patient comfort and satisfaction. Ultrasound-guided posterior sciatic nerve block offers effective anaesthesia and excellent post-operative analgesia.

Combination of Femoral and Parasacral Sciatic Nerve Block as Multimodal Pain Management in Post Hemiarthroplasty Surgery Patient

Background: The prevalence of femoral neck fractures is high in geriatric patients with a high mortality rate. Many geriatric patients have comorbidities and find it difficult to tolerate general or neuraxial anesthesia during hip hemiarthroplasty. A more safe technique in lower extremities using peripheral nerve blocks is preferred. The combination of sciatic nerve blocks and psoas compartments can supply adequate anesthesia for hip surgery thus reducing mortality. Femoral nerve blocks decrease the incidence of complications than psoas compartment blocks. Case: A 88-year-old female patient, 70 kg, with distal femoral subtrochanteric fracture accompanied by dislocation, hypertension emergency, hyperplasia heart disease (HHD), and heart failure stage B Fc II were undergoing hemiarthroplasty with regional anesthesia sciatic nerve block and femoral block. After surgery, a block was performed using regional anesthesia sub-arachnoid block bupivacaine 0,5% 7mg + fentanyl 25 µg + Morphin 0,1 µg, post-operative pain with ultrasound, the patient received 0.375% naropin and 50 mg trilac total volume 20 cm3. Then femoral block was done with 0.375% and 50 mg trilac total volume 20 cm3. Patients were observed for pain scale during hospitalization, time of mobilization, and length of stay. Post-operative hemodynamic was stable, the pain scale using VAS assessment was 0-1 during hospitalization without additional opioid analgesia, active mobilization began on the 2nd day, and the length of stay was 3 days. Conclusion: The combination of a femoral and sciatic nerve block to the proximal part of the skin incision can supply adequate pain compliance for hip hemiarthroplasty.

Comparison of Safety and Efficacy of Unilateral Spinal Anaesthesia and Ultrasound-guided Sciatic Femoral Nerve Block in below Knee Surgery: A Randomised Clinical Study

Introduction: With modern advances, Ultrasonography (USG)- guided regional block techniques have improved nerve blockade with lesser drug usage and maximum safety for patient care. The widely appreciated outpatient surgical care has compelled us to apply the fastest and safest anaesthesia technique. For lower limb surgeries, USG-guided Sciatic Femoral Nerve Block (SFNB) is an emerging alternative to Spinal Anaesthesia (SA). Aim: To compare the safety and efficacy of both techniques in terms of haemodynamic stability, quality of block, and postoperative analgesia. Materials and Methods: A randomised double-blind study conducted at GCS Medical College, Hospital, and Research Centre, Ahmedabad, Gujarat, India, on 80 patients aged 18 to 70 years of either sex, with American Society of Anaesthesiology (ASA) Grade 1 to 3, undergoing below-knee surgeries was divided into two groups. Group A received USA with 1.5 mL hyperbaric inj. ropivacaine 0.75%, and Group B received USGguided SFB with inj. ropivacaine 0.5% 30 mL (15 mL for sciatic nerve and 15 mL for femoral nerve block). Preparation Time (PT), Surgical Anaesthesia Time (SAT), haemodynamic changes, quality of block, Longevity of Anaesthesia (LoA), time of first rescue analgesia, time of spontaneous urination, readiness to discharge, and patient satisfaction were recorded. The statistical analysis was carried out using Statistical Package for Social Sciences version 23.0 (SPSS Inc., Chicago II, USA). The p-value was derived by unpaired t-test and Chi-square test. Results: PT and SAT were higher in Group B (12.10±2.02 mins and 15.74±1.58 mins) than in Group A (6.15±1.12 mins and 8.23±1.45 mins). LoA time and time to first rescue analgesic were higher in Group B (284.10±54.44 mins and 265.71±33.69 mins) than in Group A (138.75±23.30 mins and 132.40±17.41 mins). Time to first spontaneous urination and readiness to discharge were shorter in Group B (136.42±18.40 mins and 158.39±10.78 mins) than in Group A (162.20±26.54 mins and 181.53±18.18 mins). Haemodynamic stability was excellent in both groups with no significant fluctuation. Motor blockade of Bromage 3 grade was achieved in 40 and 38 patients in Group A and B, respectively. The development of VAS score &gt;3 was faster in Group A than in Group B (35 versus 2) at the end of three hours. No adverse events were observed in any patient. Conclusion: USG-guided SFB offers a safe and efficient alternative to Unilateral SA (USA) with satisfactory blockage, stable haemodynamics, and better postoperative analgesia for below-knee surgeries.

Comparative Study Between Hemi spinal Anesthesia with Fentanyl Versus Ultrasound Guided Combined Three in One Block Plus Sciatic Nerve Block in Overweight Patients Undergoing Total Knee Replacement

Comparative Study Between Hemi spinal Anesthesia with Fentanyl Versus Ultrasound Guided Combined Three in One Block Plus Sciatic Nerve Block in Overweight Patients Undergoing Total Knee Replacement

Effect of temperature-responsive hydrogel on femoral and sciatic nerve block using bupivacaine in Beagle dogs

Introduction: To compare the duration of regional anesthesia of the pelvic limb using bupivacaine with/without a temperature-responsive hydrogel (TRH) in dogs.

A Combination of Ultrasound-guided Popliteal Sciatic Nerve Block and Adductor Canal Block as a Sole Anaesthetic Technique for below Knee Amputation in High-risk Patients: A Case Series

Below-knee amputation in high-risk patients is associated with significant mortality and morbidity. Spinal anaesthesia is linked to an increased incidence of hypotension and bradycardia, and it is relatively contraindicated in patients with coagulation abnormalities. General anaesthesia is used as an alternative when spinal anaesthesia is contraindicated, but it is associated with a considerable increase in perioperative morbidity and the need for postoperative ventilatory support and Intensive Care Unit (ICU) care. A combination of sciatic nerve block and femoral block has been employed for below-knee surgeries as it provides complete anaesthesia below the knee. Adductor canal block, compared to femoral nerve block, is motor-sparing and, when combined with popliteal sciatic nerve block, offers complete anaesthesia below the knee. Below-knee amputation requires complete motor and sensory blockage, making regional block for below-knee amputation more challenging for the anaesthesiologist. Present case series is of five cases of below-knee amputation performed under a combination of ultrasound-guided popliteal sciatic nerve block and adductor canal block. Ultrasound-guided popliteal sciatic nerve block was administered with a combination of 10 mL of bupivacaine 0.5% and 5 mL of lignocaine 2% with adrenaline (1:200,000) diluted with 5 mL of distilled water to a total volume of 20 mL. Ultrasound-guided adductor canal block was performed with 8 mL of bupivacaine 0.5% and 4 mL of lignocaine 2% with adrenaline (1:200,000), diluted with 4 mL of distilled water to a total volume of 16 mL. All patients achieved adequate surgical anaesthesia, and none experienced any anaesthesia-related complications.

Long-term sciatic nerve block led by a supramolecular arrangement of self-delivery local anesthetic nano systems.

Classical local anesthetics are unsuitable to treat regional pain lasting several days due to their limited duration and systemic toxicity. Self-delivery nano systems without excipients were designed for long-term sensory blocks. 1a self-assembled into different vehicles with different fractions of intermolecular π-π stacking, transported itself into nerve cells, and released single molecules slowly to achieve long-term duration for rats' sciatic nerve block for 11.6 h in water, 12.1 h in water with CO2 and 3.4 h in NS (normal saline). After the counter ions were changed to SO42-, 1e can self-assemble into vesicles and prolong the duration to 43.2 h, which was much longer than the 3.8 h led by (s)-bupivacaine hydrocloride (0.75%). This was mainly caused by the enhancement of self-release and counter ion exchange inside nerve cells, which were affected by the gemini surfactant structure, pKa of the counter ions and π-π stacking interactions.

This Month in Anesthesiology

This Month in Anesthesiology

Popliteal sciatic nerve block in the endovascular management of critical limb ischaemia: a UK single-centre experience

Objective: This study aims to assess the safety and efficacy of the use of popliteal nerve block (PNB) in the endovascular management of patients with critical limb threatening ischaemia. Design: Single-centre retrospective observational study. Methods: All patients with rest pain who received PNB from March 2018 to August 2021 were included. Pain scores were recorded before and after block using a visual analogue scale (VAS). Requirements for analgesia or sedation, complications related to nerve block, and level of intervention were recorded. Results were compared with a historical cohort of patients prior to implementation of nerve blocks. Results: 68 nerve blocks were performed in 63 patients (M:F 46:17) of mean age 71.7 years (range 43–91). All patients were Fontaine classification III–IV. Sonographically, all nerve blocks were technically successful. The mean VAS pain score was 8.2 pre-block, reducing to 0.3 (p&lt;0.0001) post-block. There were no complications related to the block. Four patients required supplementary analgesia for breakthrough ischaemic pain. Compared with the historical comparison group of patients (n=62), there was a statistically significant reduction in the requirement for conscious sedation (p=0.004) and no procedures were abandoned due to pain compared with three in the historical comparison group (p=0.034). Conclusion: Popliteal sciatic nerve block is safe and effective in patients with critical limb threatening ischaemia undergoing lower limb endovascular intervention, significantly reducing the need for conscious sedation and risk of procedural abandonment.

Comparative Study between Single Injection Parasacral and Popliteal Approaches for Sciatic Nerve Block

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ANATOMICAL VARIATIONS OF SCIATIC NERVE - A CADAVERIC STUDY

Introduction: Sciatic nerve arises from lumbosacral plexus. It divides into tibial and common peroneal nerves from pelvis to popliteal region. The sciatic nerve usually exits from gluteal region below the piriformis muscle. Variations in course and level of division of sciatic nerve are well documented in the literature. Aim: The aim of the study is to evaluate for variations in relationship between the piriformis muscle and sciatic nerve and also the variations in the level of division of sciatic nerve. Materials and Methods: This study was done on 80 lower limbs of the 40 embalmed cadavers during routine anatomical dissections in the Department of Anatomy, Siddhartha Medical College, Vijayawada. Regions were dissected according to the guidelines and variations in sciatic nerve course and level of division were noted. Results: In this study we noted that relationships between sciatic nerve and piriformis muscle are of type A in 82.50%, type B in 8.75%, type C in 5.0%, type D in 2.5% and rare type G in 1.25%. With regard to the level of the division of sciatic nerve these are of type I in 28.75%, type II in 8.75%, type III in 6.25%, type IV in 3.75% and type V in 52.5%. Conclusion: The study establishes the variations in sciatic nerve relationship with piriformis muscle and its level of division in south Indian population. These are important to understand the variable symptoms in cases of sciatic nerve injury or compressions, complications during surgeries on gluteal region and also sciatic nerve block anesthesia.

Effects of dexmedetomidine combined with ropivacaine on the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures

To further explore the effects of dexmedetomidine combined with ropivacaine in the treatment of lumbar plexus sciatic nerve block in elderly patients with lower limb fractures. 98 patients with lower limb fractures enrolled from January 2020 to January 2022 were randomly divided into the study and control groups, with 49 cases in each group. The study group received dexmedetomidine combined with ropivacaine for nerve block; while the control group received ropivacaine for nerve block. The anesthesia effect (duration time of onset and duration time of sensory block and motor block), heart rate, blood pressure, pain score, and adverse effects were compared between the study and control groups. Patients in the study group given dexmedetomidine combined with ropivacaine for lumbar plexus sciatic nerve block had a longer duration time of sensory block and motor block than the control group, showing a better anesthetic effect. The levels of mean arterial blood pressure (MAP) and heart rate (HR) in the study group at T1, T2, T3, T4, and T5 were significantly lower than that in the control group. The pain scores of the study group was lower than that of the control group, indicating the effects of dexmedetomidine combined with ropivacaine on reducing pain. Besides, the study group showed an adverse reaction incidence of 4.08%, which was slightly higher than that of the control group, with an index of 2.04%, without statistically significant difference. Dexmedetomidine combined with ropivacaine can enhance the effect of ropivacaine block, improve the heart rate index, and reduce patients’ pain, which is one of the reliable schemes in clinical practice for lumbar plexus sciatic nerve block.

Ultrasound‐guided sciatic nerve block in two alpacas (Vicugna pacos) as part of an anaesthesia plan for hindlimb fractures

AbstractThe present case report describes the management of two alpacas undergoing repair of a metatarsal and a distal tibial fracture, respectively. Both animals received ketamine and medetomidine intramuscularly, resulting in deep sedation. Endotracheal intubation was performed, and general anaesthesia was maintained with sevoflurane. An in‐plane ultrasound‐guided sciatic nerve block was performed at the level of the mid‐thigh with bupivacaine 0.5% before surgery as part of the analgesic treatment. Meloxicam was administered. Heart rate, arterial blood pressure and respiratory rate were stable during the surgery, despite the use of a low end‐tidal sevoflurane concentration. No opioids were required intraoperatively. Duration of the anaesthesia was 205 and 255 minutes, respectively. Extubation was performed 12 and 6 minutes after discontinuing sevoflurane administration, respectively. In both cases, regional anaesthesia of the sciatic nerve improved the intraoperative management of alpacas that required surgical treatment for fractures.

Examining the impact perceptual learning artificial-intelligence-based on the incidence of paresthesia when performing the ultrasound-guided popliteal sciatic block: simulation-based randomized study

ObjectiveTo explore the impact of artificial-intelligence perceptual learning when performing the ultrasound-guided popliteal sciatic block.MethodsThis simulation-based randomized study enrolled residents who underwent ultrasound-guided sciatic nerve block training at the Department of Anesthesiology of Beijing Jishuitan Hospital between January 2022 and February 2022. Residents were randomly divided into a traditional teaching group and an AI teaching group. All residents attended the same nerve block theory courses, while those in the AI teaching group participated in training course using an AI-assisted nerve identification system based on a convolutional neural network instead of traditional training.ResultsA total of 40 residents were included. The complication rates of paresthesia during puncture in the first month of clinical sciatic nerve block practice after training were significantly lower in the AI teaching group than in the traditional teaching group [11 (4.12%) vs. 36 (14.06%), P = 0.000093]. The rates of paresthesia/pain during injection were significantly lower in the AI teaching group than in the traditional teaching group [6 (2.25%) vs. 17 (6.64%), P = 0.025]. The Assessment Checklist for Ultrasound-Guided Regional Anesthesia (32 ± 3.8 vs. 29.4 ± 3.9, P = 0.001) and nerve block self-rating scores (7.53 ± 1.62 vs. 6.49 ± 1.85, P < 0.001) were significantly higher in the AI teaching group than in the traditional teaching group. There were no significant differences in the remaining indicators.ConclusionThe inclusion of an AI-assisted nerve identification system based on convolutional neural network as part of the training program for ultrasound-guided sciatic nerve block via the popliteal approach may reduce the incidence of nerve paresthesia and this might be related to improved perceptual learning.Clinical trialCHiCTR2200055115, registered on 1/ January /2022.