Sciatic Nerve Block Research Articles

Ultrasound-guided sciatic nerve block in Wistar rat cadavers: Relevant anatomy and injection distribution

ObjectiveTo investigate the feasibility of an ultrasound-guided sciatic nerve block by describing the sonoanatomy and comparing the distribution of two volumes of bupivacaine dye solution for nerve staining. Study designRandomized, experimental, assessor-blinded cadaveric study. AnimalsA total of 40 adult female Wistar rat cadavers. MethodsAfter studying the sonoanatomy of the sciatic nerve and adjacent structures using a high-resolution linear transducer (19–5 MHz), rat cadavers were randomly divided into two groups that were administered either 0.1 mL (group 0.1) or 0.2 mL (group 0.2) of bupivacaine dye solution per nerve, delivered via an in-plane technique. The extent of nerve staining was subsequently evaluated following dissection. Statistical analysis consisted of assessing data distribution using the Shapiro–Wilk test, followed by paired t-tests for continuous data, Mann–Whitney U test and McNemar’s test for categorical data. Statistical significance was defined as p < 0.05. ResultsThe sciatic nerve was identified bilaterally as a double ellipsoid-shaped image, surrounded by a hyperechoic fascia separating the biceps femoris from the adductor muscle. The hypoechoic structure formed by the bupivacaine dye solution around the nerve was effectively visualized using ultrasound imaging. Sciatic nerve staining was successfully achieved in all pelvic limbs, with dye spread of 4.82 ± 1.55 mm and 5.47 ± 2.18 mm in groups 0.1 and 0.2, respectively (p = 0.128). Conclusions and clinical relevanceThis study achieved a detailed understanding of the sonoanatomy of the sciatic nerve and its adjacent structures, highlighting the feasibility of the ultrasound-guided technique for injection in Wistar rats. Furthermore, the results show a comparable distribution of dye solution in both groups. Use of the ultrasound-guided sciatic nerve block technique in rats not only exhibits substantial potential for regional anesthesia but also opens avenues for translational studies.

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

A comparison of the motor effects and analgesic efficacy following lumbar plexus block combined with sciatic nerve block or epidural in dogs undergoing tibial plateau leveling osteotomy

ObjectiveTo compare motor effects and analgesic efficacy following an ultrasound-guided lateral approach to lumbar plexus blockade at L7 and sciatic nerve blockade (LPSNB) against epidural injection in dogs undergoing tibial plateau leveling osteotomy (TPLO). Study designProspective, randomized, blinded clinical trial. AnimalsA total of 27 healthy adult dogs undergoing unilateral TPLO surgery. MethodsDogs were allocated to either LPSNB (bupivacaine 2 mg kg–1, 0.75%) or epidural (morphine PF 0.1 mg kg–1 and bupivacaine 0.5 mg kg–1, 0.75%). Other aspects of clinical management were identical, including anesthetic drug protocol, area of presurgical clipping and bladder care. Time to perform the block, response to surgical stimuli, pain scores, rescue analgesia, time to stand and walk, motor score and time to first urination were recorded. One evaluator, unaware of treatment status, performed all evaluations. Student’s t-test or Mann–Whitney U test was used to compare continuous variables between groups, and Fisher’s exact test for categorical variables. ResultsMedian (range) times to stand and walk were shorter for LPSNB [60 (40–120) minutes and 90 (60–150) minutes, respectively, p = 0.003] than for epidural [150 (120–240) minutes and 180 (120–360) minutes, respectively, p = 0.006]. Four dogs required rescue intraoperatively (three in epidural group, one in LPSNB group, p = 0.438). Pain scores over the 24 hour evaluation period were similar, and not significantly different, for each group. Time to spontaneous urination [LPSNB, 330 (240–360) minutes; epidural, 300 (120–1440) minutes, p = 1.0] did not differ between groups. Conclusions and clinical relevanceAn ultrasound-guided lateral paravertebral approach to the lumbar plexus within the psoas compartment at L7, combined with sciatic nerve blockade, allows faster return to normal motor function, with similar pain control and impact on urination when compared with epidural in dogs after TPLO surgery.

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.

Scorpion Venom Component; BmK AGAP Potentiates the Analgesic Effects of Lidocaine During Sciatic Nerve Block

Background: Various analgesic adjuvants, including opioids, have been tested and demon-strated to be clinically beneficial when added to local anesthetics to increase the duration of analgesia with the risk of various adverse effects. This study was designed to test the hypothesis that a scorpion venom component, BmK AGAP, may have a synergistic effect with lidocaine. Methods: We performed partial sciatic nerve ligation on 84 rats to induce a rapid onset and long-lasting mechanical allodynia. An equal volume (600μl) of lidocaine and BmK AGAP were prepared with saline. The rats were randomly assigned to one of seven groups. Group A (n = 12) received saline as the control; Group B (n = 12) received lidocaine alone; Group C (n = 12) received BmK AGAP alone; Group D, E, F and G (n = 12 each) received lidocaine and different concentrations of BmK AGAP combined. The von Frey filaments were used to assess mechanical allodynia in the rats. Results: We observed a decrease in pain intensity and a prolonged duration of analgesia in rats that received BmK AGAP with lidocaine. Conclusion: BmK AGAP with lidocaine decreased pain intensity and increased the duration of analgesia.

Nanocrystals Slow-Releasing Ropivacaine and Doxorubicin to Synergistically Suppress Tumor Recurrence and Relieve Postoperative Pain.

Although surgical resection provides a straightforward and effective treatment for most malignant solid tumors, tumor recurrence and acute postoperative pain continue to be two big problems associated with this treatment. To resolve these problems, a nanocrystal composite slow-releasing ropivacaine and doxorubicin was fabricated in this study. Briefly, a self-assembling peptide was used to form nanoparticle complexes with the two drugs, based on which homogeneous nanocrystals were obtained by adjusting the pH. In cultured human melanoma cells, the nanocrystals exhibited improved antitumor activity due to a synergistic effect and enhanced cellular uptake of the two drugs. On the other hand, the nanocrystals could slowly release ropivacaine in vitro and in vivo, generating long-acting analgesia on the rat sciatic nerve block model and incisional pain model. On a nude mouse tumor resection model, the nanocrystals simultaneously suppressed the recurrence of solid tumor and relieved postoperative pain, indicating a potential postoperative treatment for tumor resection patients. This nanocrystal system also suggested a promising and facile strategy for developing multifunctional formulations combining different drugs, which could achieve better therapeutic outcomes in a synergistic and sustained manner.

Liposomal Bupivacaine via Combined Sciatic and Saphenous Block after Lower Extremity Procedures: a Randomized, Double-Blind, Phase 3 Trial

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Combined sciatic and saphenous nerve blocks are commonly used for pain management after lower extremity procedures. Liposomal bupivacaine (LB) is a formulation of the local anesthetic bupivacaine that gradually releases bupivacaine for prolonged periods of analgesia. The objective of this phase 3 multicenter, randomized, double-blind, active- controlled study (NCT04518462) was to evaluate the postoperative analgesic effect of combined sciatic and saphenous nerve blocks with LB with or without admixed bupivacaine hydrochloride (HCl) versus bupivacaine HCl alone in adults undergoing bunionectomy or other lower extremity procedures. Methods: This study enrolled 2 parallel cohorts: pharmacokinetics, pharmacodynamics, efficacy, and safety were assessed in cohort 1 (bunionectomy), and efficacy and safety were further assessed in cohort 2 (bunionectomy, other lower extremity procedures). Eligibility criteria included American Society of Anesthesiologists physical status classification ≤3 and body mass index ≥18 to &lt; 40 kg/m2. Participants were randomized 1:1:1 to receive LB 266 mg admixed with saline (LB266), LB 266 mg admixed with bupivacaine HCl 50 mg (LB266-ADMIX), or bupivacaine HCl 100 mg (BUP100), administered as a combined sciatic and saphenous block. No additional regional blocks were administered. For 96 hours after surgery, rescue medication included nonsteroidal anti- inflammatory drugs and acetaminophen and escalation to opioids if necessary. The primary endpoint was the area under the curve (AUC) of the numerical rating scale (NRS) pain intensity scores 0-96 hours after surgery. Total postsurgical opioid consumption 0- 96 hours after surgery was a secondary endpoint. Results: In total, 119 participants were enrolled (LB266: n=40; LB266-ADMIX: n=41; BUP100: n=40). The least squares mean (LSM) AUC of the NRS pain intensity score was nonsignificantly lower 0-96 hours after surgery for LB266 versus BUP100 (LSM [standard error], 286.9 [32.9] vs 348.6 [34.4]; LSM difference vs BUP100, −61.7 [95% confidence interval (CI), −147.0, 23.6]; P=0.1564). LB266 pain intensity scores were significantly higher 6-18 hours after surgery but were significantly lower at 36-96 hours than BUP100 (Figure). Cumulative opioid consumption differences 0-96 hours after surgery for LB266 versus BUP100 were not significant (LSM [95% CI], 20.7 [13.5, 31.7] vs 19.8 [12.7, 31.0]; P=0.8857). Mirroring pain scores, opioid consumption with LB266 versus BUP100 was higher at 0-24 hours but lower 24-96 hours (Figure); adverse events were similar. Conclusion: Cumulative pain intensity and opioid consumption were not significantly different between the LB266 and BUP100 groups 0-96 hours after surgery; however, consistent with the known mechanism of LB, pain intensity scores were significantly lower with LB266 36-96 hours after surgery, and opioid consumption was significantly lower 24-96 hours after surgery.

Effects of two different topographic approaches for combined sciatic and femoral nerve block in calves, guided by ultrasound and neurostimulation

To evaluate the sensory and motor effects promoted by a combined sciatic and femoral nerve block in calves using two approaches. Six calves were used, in a crossover study. Ultrasound combined with neurostimulation, was used to perform the following block combinations: the proximal approach (PA), which consisted of the association of the parasacral approach (sciatic nerve block) and ventral to the ilium approach (femoral nerve block); distal approach (DA) consisted of the association of a lateral approach to the pelvic limb approach (sciatic nerve block), and an inguinal approach, underneath the femoral trigone (femoral nerve block). Pressure algometry and motor function of the limb where evaluated. Mechanical nociceptive threshold (MNT) increase, and ataxia duration means were 9.5 ± 0.7 kg and 10.4 ± 3.9 hr for PA and 10.4 ± 3.9 kg and 12.7 ± 1.9 hr for DA, respectively with no significant difference. There was no significant difference between MNT elevation time and the duration of ataxia using the same approach. The DA treatment showed significant MNT elevation in 72% of the tested regions, while the PA treatment showed an elevation in 100% regions tested. Topographic approaches closer to where the spinal nerves emerge produced a larger desensitised area.

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.

Differential blockade, comparative study of different ropivacaine concentrations (0.75%; 0.2%; 0.12%) for ultrasound guided sciatic and femoral nerve blocks in calves: Prospective cross-over study

Pharmacodynamic understanding of the different local anesthetic concentrations allows adapting their use to diverse clinical/surgical procedures, such as intraoperative and/or postoperative analgesia. A crossover study was performed, where 6 calves (5 male and 1 female), weighing 120 ± 28 Kg, were subjected to combined sciatic and femoral nerve block using three ropivacaine concentrations. The treatments were: R0.75, using 0.75% ropivacaine; R0.2, 0.2% ropivacaine; and R0.12%, 0.12% ropivacaine. All treatments were performed with ultrasound and neurostimulation assistance, and a volume of 0.1 mL/kg of the respective local anesthetic solution was administered in each block point. The sites of mechanical nociceptive threshold (MNT) evaluation were based on the calf pelvic limb dermatomes. The proportion between desensitized areas, MNT elevation time and level of ataxia were registered. Elevation of MNT occurred in 100% of the tested areas in the R0.75 and R0.2 treatments, and in 82% of the R0.12 treatment. Mean MNT elevation times were 9.5 ± 0.7 h for R0.75, 6 ± 0.8 for R.02, and 2.4 ± 2.3 for R0.12, differing significantly between all treatments. No difference was observed between MNT elevation time and ataxia duration time, in each treatment. It is concluded that the duration of sensory-motor effects is dose-dependent, but there was not possible to detect block selectivity as the concentrations was reduced. More desensitized areas and extension were obtained with the use of higher concentrations.

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.

Achieving Long-Acting Local Analgesia Using an Intelligent Hydrogel Encapsulated with Drug and pH Regulator.

Local anesthetics are important for the treatment of postoperative pain. Since a single injection of the solution of a drug such as bupivacaine (BUP) works only for a few hours, it is much required to develop a long-term injectable formulation that maintains its efficacy for more than 1 day. Herein, an intelligent copolymer hydrogel loaded with BUP microcrystals was invented. The biodegradable block copolymer was synthesized by us and composed of a central hydrophilic poly(ethylene glycol) (PEG) block and two hydrophobic poly(lactide-co-glycolide) (PLGA) blocks. The aqueous system of the amphiphilic copolymer underwent a sol-gel transition between room temperature and body temperature and, thus, physically gelled after injection. Considering the decrease of solubility of BUP with the increase of pH and the internal acidic environment due to the hydrolysis of PLGA, calcium carbonate (CaCO3) powder was introduced as a pH regulator. Then, the internal pH was found to be nearly neutral and many BUP microcrystals were dispersed in the gel network. In this way, BUP had achieved a sustained release out of the thermogel. The maximum possible effect (MPE) in a rat sciatic nerve blockade model was used to describe the sensory blockade effect. In vivo analgesic effects evaluated with a hot plate experiment of rats demonstrated that the thermogel encapsulated with BUP microcrystal and CaCO3 powder significantly prolonged analgesia up to 44 h, the duration time with respect to 50% MPE. The intramuscularly injected implant exhibited biocompatibility in histological analyses. Besides, the untreated leg of the rats was not influenced by the treated leg, indicating no obvious systematic anesthesia of this hydrogel formulation. Such an intelligent and composite formulation represents a potential strategy for long-acting analgesia therapy.

Anaesthetic management in patient with left ventricular clot posted for non-cardiac surgery

Cardiovascular disease remains the leading cause of mortality all over the world. Mortality from acute myocardial infarction (AMI) has decreased since the introduction of primary percutaneous coronary intervention (PCI). Left ventricular (LV) thrombus is a common complication after acute myocardial infarction (MI). One of the most feared complications is the occurrence of thromboembolic events (mostly cerebrovascular accidents) due to left ventricular (LV) thrombus formation. We present a 65 yrs old male with right traumatic foot ulcer, scheduled for right foot SSG. His ECG showed anterior wall ischemic changes. Echocardiogram showed akinetic LV apex, EF: 47%, with an organised LV apical clot of 1.5×1.4cm. Cardiologist opinion was obtained and he was put on oral nitrates, beta blocker and statins. Surgery was done under right popliteal sciatic nerve and fascisa iliaca block. Intraoperative period was uneventful. Postoperatively, serial ECG and Trop I was done on 1 and 4 POD and was found to be normal. He was discharged on 4 POD, with advice to follow up with cardiologist.

Endovascular revascularization of critical limb ischemia: the role of ultrasound-guided popliteal sciatic nerve block for the procedural pain management.

To evaluate the impact of the ultrasound-guided popliteal sciatic nerve block (PSNB) for pain management during endovascular treatment of chronic limb-threatening ischemia (CLTI). From November 2020 to January 2022, 111 CLTI patients that underwent endovascular procedures were prospectively enrolled in this prospective single-arm interventional study. Ultrasound-guided PSNB was used for procedural pain control. Pain intensity was evaluated throughout the procedure (baseline, 10min after the block, pain peak, and at the end of the procedure) with the visual analog scale (VAS). Forty-six patients underwent above-the-knee revascularization (ATK), 20/111 below-the-knee (BTK) revascularization, 20/111 to both ATK and BTK revascularization. In 25 cases, no endovascular option was feasible at diagnostic angiography. The PSNB was effective in 96% of patients, with no need for further pain management with a statistically significant reduction (p < 0.0001) in the mean value of the VAS from 7.86 ± 1.81 (pre-procedural) to 2.04 ± 2.20 after 10min from the block and up to 0.74 ± 1.43 at the end of the procedure (mean time 43min). Only 1 complication related to the popliteal sciatic nerve block was registered (a temporary foot drop, completely resolved within 48h). The time necessary to perform the block ranged between 4 and 10min. Ultrasound-guided PSNB is a feasible and effective method to manage patients with rest pain and increase comfort and compliance during endovascular procedures. An ultrasound-guided popliteal sciatic nerve block is a safe, feasible, and effective technique to manage pain during endovascular treatment of chronic limb-threatening ischemia, especially in frail patients with multiple comorbidities who are poor candidates for deep sedoanalgesia or general anesthesia. Endovascular treatment of CTLI may require long revascularization sessions in patients with high levels of pain at rest, which could be exacerbated during the revascularization procedure. The PSNB is routinely used for anesthesia and analgesia during foot and ankle surgery, but the experience with lower limb revascularization procedures is very limited and not included in any international guideline. Ultrasound-guided PSNB is a feasible and effective regional anesthesia technique to relieve procedural and resting pain. Because of its safety and availability, every interventional radiologist should know how to perform this type of loco-regional anesthesia.

A Case Report: Combined Sciatic Nerve and Lumbar Plexus Nerve Block in A Patient with Acute Decompensated Heart Failure Undergoing Lower Extremity Surgical Debridement

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peripheral nerve block for lower extremity surgeries requires a minimum of two block injections. Although the combination of the lumbar plexus block and the sciatica block is a procedure that requires large doses of local anesthetic, which may induce cardiotoxicity, a recent study suggests that change in the hemodynamic system is not clinically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Description:&lt;/strong&gt; We report a case of a 53-year-old male presenting with a worsened shortness of breath two days before hospital admission. He also experienced a sudden high fever and pain on his right thigh. The patient had a history of Heart Failure (EF 28%) and Congestive liver disease and was diagnosed with right femur cellulitis with right phlegmon. Surgical debridement was planned to treat sepsis. Right lumbar plexus block and right sciatica block were performed as surgical anesthesia. The surgery duration was one hour, and the patient was transferred to the PACU. The patient was treated in ICU before being admitted to the general ward and was discharged on day three post-surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The combination of Sciatic nerve and lumbar plexus nerve block is an effective anesthesia and analgesia technique for lower limb surgery in individuals with a severe heart condition. &lt;/p&gt;

Postoperative analgesic effectiveness of ultrasound guided combined femoral - sciatic nerve block versus combined adductor canal block – I PACK block in patients undergoing total knee arthroplasty: A double- blind randomized study

ABSTRACT Background For successful rehabilitation and optimal functional outcomes after total knee arthroplasty surgery, patients must have effective pain control. Peripheral nerve blocks offer an excellent solution for perioperative multimodal analgesia and are advocated to reduce postoperative opioid consumption. Objectives The objective of this study is to compare the efficacy of combined Femoral-Sciatic nerve block and Adductor- interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block in terms of total rescue analgesia dosage and ambulation on the first postoperative day. Method This is a prospective, randomized, double-blinded trial was conducted at Ain Shams University Hospital. Sixty patients scheduled for total knee arthroplasty (TKA) were randomly divided into two equal groups: one group received a Femoral-Sciatic nerve block, and the other received an Adductor-IPACK block. Both ultrasound-guided blocks were performed by injecting 20 mL of 0.25% bupivacaine immediately after anaesthesia induction. The postoperative opioid requirement in the first 24 hours was assessed using the visual analogue scale (VAS). Motor power, intraoperative fentanyl consumption, intraoperative hemodynamic changes, procedure time, surgery duration, tourniquet time, and technique complications were also recorded. Results Femoral-Sciatic group had lower opioid consumption. The Adductor-IPACK group showed a statistically significant higher Modified Bromage score. However, there was no statistically significant difference between the groups in the postoperative pain score assessed using the VAS. Conclusion Based on our study, we conclude that Femoral-Sciatic blocks required a lower dose of rescue analgesia compared to the Adductor-IPACK group. The Adductor-IPACK group also experienced lesser postoperative muscle power impairment.

Ultrasound-Guided Popliteal Sciatic Nerve Block: A Minimally Invasive Method for Pain Control During Endovascular Treatment of Critical Limb Ischemia

PurposeTo evaluate the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block (PSNB) for pain control in endovascular treatment of critical limb ischemia (CLI). Materials and MethodsThis retrospective study included 252 patients who underwent endovascular treatment for CLI between January 2020 and August 2022. Of these, 69 patients underwent PSNB, whereas moderate procedural sedation and analgesia was delivered in 183 patients. Pain scores were assessed using the visual analog scale (VAS) before and during the intervention. Technical and clinical success of PSNB, duration of the procedure, time to onset of nerve block, time for block resolution, and adverse events were recorded. Patient and operator satisfaction were assessed using the Likert scale. ResultsAll PSNB procedures were technically and clinically successful, and the mean procedural duration of PSNB was 5.0 minutes ± 0.8 (range, 4–7 minutes). Prolonged effect of PSNB was observed in 3 patients, which resolved within 24 hours. No adverse events were encountered. Median VAS score was significantly lower in the PSNB group than in the moderate procedural sedation and analgesia group during endovascular treatment (0 [range, 0–2] vs 3 [range, 0–7]; P < .001). Patient satisfaction was comparable (“very satisfied” in 66 [95.7%] vs 161 [88.0%]; P = .069). However, operator satisfaction was significantly higher in the PSNB group (“very satisfied” in 69 [100%] vs 161 [88.0%]; P = .003). ConclusionsPSNB is safe and effective for pain control during endovascular treatment of CLI. Low adverse event rates with high patient and operator satisfaction make PSNB a reasonable alternative for high-risk patients.

Anaesthesia for a child with α-dystroglycan-related congenital muscular dystrophy

α-Dystroglycanopathy is a newly emerging subcategory of autosomal recessive inherited muscular dystrophies which encompasses a wide spectrum of clinical severity. Mutation of at least 18 genes which are responsible for O-mannose glycosylation of α-dystroglycan has been linked to these congenital muscular dystrophy phenotypes. α-Dystroglycan-related congenital muscular dystrophy (αDG-CMD), which may be associated with multisystem involvement, poses a challenge in perioperative management. Yet, there is a dearth of resources available for reference. We report successful anaesthesia for a 6-year-old child with αDG-CMD who underwent bilateral hamstring lengthening, left Achilles tendon lengthening, and above-the-knee fibreglass for bilateral hamstring tightness. Anaesthesia was performed using total intravenous anaesthesia (TIVA) without muscle relaxant. Bilateral sciatic nerve blocks were performed for postoperative pain control, allowing opioid-free analgesia. The patient was extubated at the end of the surgery. Perioperative considerations in αDG-CMD include anticipation of difficult airway, maintenance of thermoregulation and precautions against malignant hyperthermia with the employment of TIVA, techniques that avoid opioids and neuromuscular blocking agents (particularly suxamethonium), as well as minimizing the risk of aspiration and of raised intracranial pressure.

Ultrasound guided sciatic nerve blockade - subgluteal and popliteal approaches.

Sciatic nerve blocks are commonly performed regional anaesthetic blocks used for lower limb surgery. The two most common sciatic nerve blocks are briefly reviewed in this article, with particular reference to ultrasound guidance.