Ultrasound-guided Sciatic Block Research Articles

Ultrasound-Guided Popliteal Sciatic Block Provides Adequate Analgesia During Urgent Endovascular Treatment of Critical Limb Ischemia with Resting Pain.

To demonstrate feasibility and safety of ultrasound-guided popliteal sciatic nerve block for providing analgesia during urgent endovascular treatment of critical limb ischemia with resting pain. Ultrasound-guided popliteal sciatic blocks were performed by an interventional radiologist in angiography suite immediately prior to commencement of urgent endovascular treatment of 30 critical limb ischemia patients. Subjective pain levels prior to and following sciatic block were assessed using the visual analog scale (VAS). Need for any supplemental anxiolytics or analgesics during treatment was recorded. Post-procedural evaluation of patient and operator satisfaction levels regarding the intervention was also documented. Ultrasound-guided sciatic block provided adequate analgesia in all patients; VAS scores were 0 (no pain) in 87% and 1-3 (mild to annoying pain) in 13%. Two patients required anxiolytic premedication. Additional analgesia was not required during course of endovascular treatment of any patients. Time necessary to perform sciatic block ranged 3-9 (mean 5.9±1.3) min. Median number of needle attempts was 1 (range 1-3). Onset of satisfactory block ranged from 5 to 20min (mean 9.4±2.6min). Mean treatment time was 102.2±36.7min, and balloon time was 22.4±6.1min. Patient and operator satisfaction with pain control were very good in all cases. There were no procedure-related complications. Ultrasound-guided popliteal sciatic block is a feasible and safe alternative for providing adequate analgesia during urgent endovascular treatment of critical limb ischemia with resting pain. Level 4, case series.

0.5% levobupivacaine versus 0.5% ropivacaine: Are they different in ultrasound-guided sciatic block?

Context and Aims:Little is known about onset and duration of sciatic block after 0.5% levobupivacaine (Levo) versus 0.5% ropivacaine (Ropi) for ultrasound-guided technique. We assessed these parameters in the ultrasound-guided block, to know for the practice.Setting and Design:A comparative randomized double-blind study was conducted in the University Hospital.Materials and Methods:Were included 35 adults of ASA I-II, scheduled for foot surgery, presenting clear imaging of their sciatic nerve at mid-thigh. A volume of 20 mL of either 0.5% Levo or 0.5% Ropi were injected around the sciatic nerve at mid-thigh using ultrasound guidance (out of the plane) followed by placement of a catheter to use, if necessary, for perioperative analgesia. A femoral single shot block was systematically performed to block the saphenous nerve. The onset times until complete foot block (primary outcome) and the sensory and motor block duration (secondary outcome) were assessed using Wilcoxon test. Values were expressed as medians (1st-3rd quartile).Results:Except for two delayed sciatic blocks in each group, the onset time otherwise was 35 min (20-60) in Ropi versus 40 min (30-60) in Levo, P = 0.5. Sensory block lasted longer in Levo, 17 h (14-27) compared with 15 h (10-17) in Ropi, P = 0.04. No significant between-group difference was found with motor block durations, 15 h (12-18) in Levo and 15 h (12-16) in Ropi, P = 0.3.Conclusion:No difference of onset times was found in ultrasound-guided sciatic block whether using Levo or Ropi. Levo induced a longer-lasting sensory block.

Ultrasound‐guided infragluteal sciatic nerve block: a comparison between four different techniques

Ultrasound guided sciatic block can be performed by different techniques. We compared namely short or long axis views of the sciatic nerve with in-plane or out-of-plane needle insertion techniques for the infragluteal sciatic nerve block (ISNB). One hundred twenty patients with American Society of Anesthesiologists physical status I-III, scheduled for foot surgery were assigned into four groups. Group SI: patients received ultrasound-guided SNB using short axis (S) view of the SN and in-plane (I) insertion of needle. Group LI: patients received SNB using long axis (L) view of SN and (I) insertion of the needle. Group SO: patients received SNB using (S) view of SN and out-of-plane (O) insertion of the needle. Group LO: patients received SNB using (L) view of SN and (O) insertion of the needle. Primary outcomes included the time to perform the block (recognition and performance time) and the level of patient discomfort during block placement. The recognition time and performance time were shortest in LI group (51 ± 16.4 and 87.7 ± 14.8 s), while they were longest in LO group (138.7 ± 21.4 and 160.3 ± 17.5 s). There were no significant differences between the groups as regards the number of attempts and needle redirections to elicit sciatic motor response. The level of patient discomfort was significantly less in the LI group in comparison with the SI and LO groups. The LI approach required less time to complete the infragluteal sciatic nerve block procedure and it was more comfortable for the patients in comparison to the SO, SI and LO approaches.

Extraneural versus Intraneural injection of local anesthetic during ultrasound-guided sciatic block

s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Local and Regional Anaesthesia