Ultrasound-guided Sciatic Nerve Research Articles

How I Do It: Ultrasound-Guided Sciatic Nerve Block at the Popliteal Fossa

How I Do It: Ultrasound-Guided Sciatic Nerve Block at the Popliteal Fossa

Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block

BackgroundContinuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success.MethodsEighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 min after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%).ResultsThe degree of nerve blockade at 30 min as judged by median (10th, 90th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02).ConclusionsInjection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound.Trial registrationNCT01591603

Comparison of unilateral spinal anaesthesia with ultrasound-guided combined sciatic and femoral nerve block in elective arthroscopic knee surgeries

BackgroundArthroscopic knee surgeries are commonly performed orthopaedic procedures, which can be done under unilateral spinal anaesthesia (USA) or ultrasound-guided combined sciatic and femoral nerve block (USFB). However, not many studies have compared both these techniques. Hence this study was undertaken to compare USA and USFB in arthroscopic knee surgeries in terms of time to readiness for discharge (TRD). MethodsEighty patients were randomised into the USA (n = 40) and USFB groups (n = 40). They were administered either USA or USFB on the affected side. The TRD values were compared. Patients were considered fit for discharge after voiding urine, ambulation and obtaining a visual analogue scale (VAS) score of <3. The maximum time required for any of the three parameters was taken as the TRD for that particular patient. ResultsThe mean TRD was 595.41 ± 195.69 min in the USA group and 351.86 ± 129.51 min in the USFB group (p < 0.001). The median VAS scores for postoperative pain assessment were lower in the USFB group at 2, 4, 12 and 24 h (p < 0.05). The number of patients requiring rescue analgesia was lower in the USFB group at 6 and 12 h after surgery (p < 0.05). ConclusionPatients undergoing arthroscopic knee surgeries under USFB have an advantage when it comes to TRD as these patients have comparatively better postoperative analgesia, less requirement of rescue analgesia, early voiding of urine and early ambulation.

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

ObjectivesThe aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture.MethodsA total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded.ResultsThe VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05).ConclusionUltrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture.Trial registrationChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526.

Refining the rat sciatic nerve block: a novel ultrasound-guided technique.

Murine translational models are an important tool to understand pain pathophysiology. One procedure used frequently in murine research is the sciatic nerve block. This study sought to demonstrate the use of ultrasound-guided sciatic nerve block in a cadaveric murine model. A total of 40 injections were performed in 20 Sprague-Dawley male 18-month-old rat cadavers. Necropsy was performed to identify staining of the sciatic nerve. Staining with methylene blue occurred in 40 of 40 ultrasound-guided injections. The extremely accurate nature of this block under ultrasound guidance is favorable for future translational studies in rats undergoing sciatic nerve blocks. This method may represent a significant improvement in current methods.

Impact of combined nerve blocks on the outcome of hip replacement in elderly patients with acute cerebral infarction

Objective: To investigate the impact of ultrasound-guided lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks on the outcomes of elderly acute cerebral infarction patients with femoral neck fracture who underwent hip replacement. Methods: The clinical data of 114 elderly acute cerebral infarction patients with femoral neck fracture and underwent artificial hip replacement surgery from May 2013 to September 2018 in Renmin Hospital of Wuhan University were retrospectively analyzed. The patients were divided into two groups based on the different anesthetic methods they received: general anesthesia (G group, n=48), lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks (N group, n=66). The operation time, anesthesia time, blood loss, urine volume, norepinephrine dose, length of intensive care unit (ICU) stay, hospital mortality and postoperative 6-month mortality were observed and compared between the two groups. The mini-mental state examination (MMSE) scores and the national institute of health stroke scale (NIHSS) scores were evaluated, respectively. Meanwhile, plasma D-Dimer and S100β levels were measured 1 d before surgery, 3 d and 7 d after surgery. Results: There were no significant differences in the baseline characteristics, operation time, anesthesia time, blood loss and length of ICU stay between the two groups (all P>0.05). Compared with group G, the dosage of norepinephrine [(86±23) μg vs (184±28) μg], hospital mortality [7.6% (5/66) vs 25.0% (12/48)] and postoperative 6-month mortality [12.1% (8/66) vs 31.3% (15/48)] were significantly decreased in group N, while the urine volume [(265±58) ml vs (160±55) ml] was significantly increased (all P<0.01). The MMSE scores (9.9±3.0 vs 14.6±2.4) in group N were significantly higher than those in the group G 3 d after surgery, while the NIHSS scores (15.3±3.2 vs 9.9±3.5), plasma D-Dimer [(10.8±2.5) mg/L vs (7.3±2.2) mg/L] and S100β levels [(326±35) ng/L vs (276±29) ng/L] were significantly lower than those in group G (all P<0.01). Conclusion: Combined nerve blocks can reduce the mortality of acute cerebral infarction patients undergoing hip replacement surgery, and improve the brain function and prognosis of the patients.

Observation on the Anesthesia Effect of Ultrasound-Guided Nerve Block for Elderly Patients with Lower Limb Fractures

Objective: To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures. Methods: From November 2017 to November 2020, 50 elderly patients with lower limb fractures in our hospital were divided into experimental group (25 cases, general anesthesia + femoral nerve and sciatic nerve block) and control group (25 cases, general body anesthesia). Compare the MAP, HR, anesthesia effect, and adverse reactions between the two groups at each time period. Results: Before induction, the difference in MAP and HR between the two groups of patients did not form, p&gt;0.05; the MAP and HR of the experimental group were compared with the control group at the time of skin incision, 1 hour during the operation, and removal of the laryngeal mask, P?0.05; the time of extubation in the experimental group (14.28±3.18) min, awake time (5.57±1.32) min, orientation recovery time (11.89±2.23) min, propofol dosage (191.36±22.48) mg, remifentanil dosage (0.23±0.04) mg, Compared with the control group, P&lt;0.05; the adverse reaction rate of the experimental group (8%, 2/25) was lower than that of the control group (32%, 8/25), P&lt;0.05. Conclusion: The use of ultrasound-guided femoral nerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia, effectively reduce the use of anesthetics, and have fewer adverse reactions. It is worthy of promotion.

Retrospective comparison of three locoregional techniques for pelvic limb surgery in dogs

ObjectiveTo retrospectively compare the efficacy and duration of effect of three commonly used locoregional blocks in dogs undergoing pelvic limb orthopaedic surgery. Study designRetrospective clinical study. AnimalsA total of 236 dogs that underwent pelvic limb surgery and were administered a locoregional technique. MethodsA total of 236 hospital records were reviewed and 230 included in statistical analysis. Dogs were grouped as following: electrostimulation-guided pre-iliac femoral and sciatic nerve block (group PFS, n = 70); ultrasound-guided saphenous and sciatic nerve block (group SS, n = 76); or lumbosacral epidural (group EPI, n = 84). In group EPI, bupivacaine 0.5% or ropivacaine 0.75% was used with morphine. Dogs were pain scored (short form of the Glasgow Composite Measure Pain Scale) hourly following recovery from anaesthesia. Analysed data included: time to first postoperative dose of methadone, pain score at that time, intraoperative rescue analgesia, intraoperative hypotension and ability to walk and urinate overnight. Separate analyses were performed including all pelvic limb surgeries and including only elective stifle surgeries. Kruskal–Wallis and Mann–Whitney tests were performed. A p value < 0.05 was considered significant. The median (range) is reported. ResultsFor all pelvic limb surgeries, the time to first postoperative methadone was 530 (110–1337), 440 (140–1030) and 466 (135–1094) minutes in groups EPI, PFS and SS, respectively, and was not significantly different. Postoperatively, 10/84, 15/70 and 12/76 dogs in groups EPI, PFS and SS, respectively, did not require methadone (nonsignificant). Significantly fewer dogs in group EPI (18%) required intraoperative rescue analgesia compared with group SS (38%), but not compared with PFS (30%). Significantly more dogs in group EPI had hypotension intraoperatively (30%) and urinary retention postoperatively (62%). Conclusions and clinical relevanceIntraoperative analgesia may be superior with EPI than SS for some surgeries of the pelvic limb, but not for stifle surgeries. All three techniques provided similar requirement for postoperative analgesia, but EPI caused higher incidence of intraoperative hypotension and postopertive urinary retention.

Use of Continuous Electrical Impedance Measurement for Accurate Nerve Block in Rabbits.

To perform an effective and safe nerve block, the needle must be placed near the target nerve while avoiding nerve damage. Our objective was to conduct an animal study to determine whether changes in electrical impedance (EI) could be used to guide the needle and achieve a safe and accurate nerve block. We measured the EI of rabbit tissues during ultrasound-guided sciatic nerve block using a bipolar needle via the in-plane needle approach. The EI values and needle track on the ultrasound monitor were video-recorded. When there was a change in the EI, the needle advancement was stopped, and a stained anesthetic was injected. Subsequently, the animals were euthanized, and the anesthetic-stained tissue was examined via dissection, while the other tissue was preserved at -80°C for microscopic analysis. The EI remained stable as the needle advanced through the muscle (extraneural); however, it markedly decreased when the needle tip contacted the nerve or slightly punctured the epineurium (paraneural). The mean extra- and paraneural EIs were 4.92 ± 1.31 kΩ (range, 2.39-9.67 kΩ) and 2.86 ± 0.96 kΩ (range, 1.66-5.13 kΩ), respectively. Examination of the dissections and cryostat sections showed anesthetic delivery around the nerve. EI values differed between extra- and paraneural sites, and monitoring these values allowed prediction of the needle tip location with respect to the target nerve. Real-time EI measurement could improve the nerve block.

Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study

ObjectiveTo determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO). Study designProspective, masked, pilot, randomized, clinical trial. AnimalsA total of 40 client-owned dogs undergoing TPLO. MethodsEach dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg–1 of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg–1) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg–1) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05. ResultsGroups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041). Conclusions and clinical relevanceCombined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.

Ultrasound-guided subparaneural popliteal sciatic nerve block: there is more to it than meets the eyes

The popliteal sciatic nerve block is routinely used for anesthesia and analgesia during foot and ankle surgery. This article reviews our current understanding of the anatomy of the sciatic nerve...

Ultrasound-guided transgluteal sciatic nerve analgesia for refractory back pain in the ED

Sciatic radicular back pain is a painful condition resulting in approximately 2% of emergency department (ED) visits a year. Typically, the ED treatment has been limited to various analgesic regimens with limited success sometimes resulting in hospital admissions for pain control. Regional anesthesia has become increasing popular for lower-limb analgesia, but has not universally permeated the ED setting. The transgluteal sciatic nerve block (TGSNB) is a procedure that can provide effective analgesia for lower extremity pain. Herein, we present the first technical description and clinical response to ultrasound-guided TGSNB performed by emergency physicians for acute pain control of sciatic back pain through a series of cases.

Comparison of the learning curves of novice anaesthetists using needle tip tracking during simulated ultrasound-guided sciatic regional nerve block on the soft embalmed Thiel cadaver

Comparison of the learning curves of novice anaesthetists using needle tip tracking during simulated ultrasound-guided sciatic regional nerve block on the soft embalmed Thiel cadaver

Mean effective volume of local anesthetics by nerve conduction technique

BackgroundThis study aimed to investigate whether nerve conduction could be used to objectively evaluate mean effective volume of 1.5% lidocaine after subparaneural or extraparaneural injection.MethodsTwenty patients undergoing unilateral foot or ankle surgery were randomized into either subparaneural or extraparaneural injection group, and ultrasound-guided continuous popliteal sciatic nerve block was performed. The action potential amplitude of the distal gastrocnemius muscle was monitored. The time of anesthesia onset and dosage of lidocaine were recorded when amplitude declined to 0.5 mV. The operative analgesic effect, score of numeric rating scales, patient’s satisfaction, and movement or sensation were recorded during or after surgery.ResultsPreoperative dose of local anesthetics (10.7±1.6 vs. 16.2±1.2 mL) and the time of onset (19.4±3.3 vs. 30.4±2.5 min) reduced significantly in the subparaneural group (P<0.05). The intra-operative analgesic effect (1.2±0.422 vs. 1.3±0.483) and the score of resting numeric rating scales (0.6±1.0 vs. 1.9±2.1 and 0.4±0.7 vs. 1.2±1.1) 24 and 48 h after surgery were comparable between groups, but the subparaneural group had markedly lower scores of activity numeric rating scales (0.3±0.6 vs. 2.1±2.0, 0.7±1.2 vs. 2.2±1.9 and 0.5±0.8 vs. 1.5±1.2) at 6, 24 and 48 h, and significantly higher satisfaction (9.7±0.5 vs. 8.8±0.8) (P<0.05). There were no obvious symptoms of movement or sensation within 3 days in two groups.ConclusionsThe nerve conduction can be used to objectively evaluate the mean effective volume of 1.5% lidocaine in different injection groups, and subparaneural injection has more advantages as compared to extraparaneural injection for continuous popliteal sciatic nerve block.

Ultrasound-guided femoro–sciatic nerve block with and without using nerve locator for below-knee surgeries

Background Femoral and sciatic nerve blocks is a suitable technique for below-knee surgeries compared with neuroaxial and general anesthetic techniques. Objectives To evaluate the efficacy of ultrasound-guided femoral and sciatic nerve blocks with and without using a nerve locator in below-knee surgeries. Patients and methods Between May 2017 and May 2018, we conducted our randomized, observer-blinded prospective clinical study. Sixty patients underwent below-knee surgeries in Menoufia University Hospitals were involved and divided into two groups of 30 patients each. The groups were assigned into two: group A received ultrasound-guided femoral and sciatic nerve block and in group B, nerve block was done using combined ultrasound with a nerve locator. Results The onset time of motor block was significantly shorter in the nerve locator group than in the ultrasound-only group (P Conclusion Adding nerve locator to the ultrasound-guided nerve block technique has minimal impact on the efficacy of the technique.

Ultrasound-guided psoas compartment and sciatic nerve blocks for pain management of hind limb procedures in the alpaca (&lt;i&gt;Vicugna pacos&lt;/i&gt;)

Background:Loco-regional anesthetic techniques are considered important in the multimodal approach to analgesia in both human and veterinary medicine. No such techniques are described in the alpaca, bar the use of epidural. This is in part due to the lack of anatomical description for this species. While this limitation exists, the use of ultrasound guidance makes peripheral nerve blocks a viable possibility in the alpaca.Case description:A 12-month-old alpaca was referred for the treatment of a septic left tarso-crural joint. Due to a poor prognosis, amputation of the limb under general anesthesia was performed. Sciatic and psoas compartment blocks were attempted with the ultrasound-guided injection of ropivacaine prior to the start of the procedure. While the femoral nerve was possible to visualize, no obturator nerve was identified. A 5-year old alpaca was also referred for a left hind lateral claw removal, due to a squamous cell carcinoma. The sciatic nerve block was performed prior to the claw amputation under general anesthesia. No changes in heart and respiratory rate, or blood pressure suggestive of nociception, were observed in either of these cases. At the end of both the procedures, the patients experienced uneventful recoveries characterized by the ability to maintain the standing position, interest in food, and normal behavior.Conclusion:This report identifies the ease of performance and the challenges encountered using the ultrasound-guided psoas compartment and sciatic nerve blocks in the alpaca. It is our hope that this report encourages the use of ultrasound-guided loco-regional techniques in this species.

Effects of dexmedetomidine combined with bupivacaine on sciatic nerve blockade in dogs

Introduction: Ultrasound-guided peripheral nerve blocks are increasingly used for perioperative anesthesia and analgesia in dogs. This study assessed how the addition of dexmedetomidine to bupivacaine affects the duration of motor and sensory blockade following ultrasound-guided sciatic nerve blocks.

Sex-dependent prolongation of sciatic nerve blockade in diabetes patients: a prospective cohort study

IntroductionDiabetes may affect the duration of nerve block after regional anesthesia. This study aimed to compare the durations of sensory and motor block in diabetes versus non-diabetes patients after lower...

Proximal lateral approach to ultrasound-guided sciatic nerve block: where is the correct injection site?

To the editor We thank Dr Yoshida et al [1 2][1] for their interest in our article[3][2] and acknowledge their recent contribution to the literature on ultrasound-guided proximal sciatic nerve...

Financial impact of ultrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation for tibial plateau leveling osteotomy surgery in dogs

ObjectiveTo determine the anesthesia cost from ultrasound-guided lumbar plexus and sciatic nerve blocks confirmed with electrostimulation for unilateral tibial plateau leveling osteotomy (TPLO) surgery in dogs. Study designProspective, randomized, blinded clinical trial. AnimalsA group of 20 dogs weighing 33.9 ± 6.0 kg (mean ± standard deviation). MethodsAll dogs were administered hydromorphone and atropine, propofol for induction of anesthesia and isoflurane for maintenance. Hydromorphone and carprofen were administered for recovery. The dogs were randomly assigned to one of two groups, lumbar plexus and sciatic nerve blocks with ropivacaine [regional anesthesia (RA)] or sham blocks with saline [control (CON)]. Fentanyl was administered for rescue analgesia intraoperatively and postoperatively. The cost to manage anesthesia was divided into fixed and variable costs using the micro-costing method. The variable costs were compared using Student’s t test or Mann–Whitney U test. ResultsThe fixed anesthesia costs were equal between groups at US$354.00 per case. The variable anesthesia cost range was US$27.90–100.10 for RA and US$21.00–180.50 for CON. Overall, cost per dog in CON was from –US$6.9 to US$80.4 compared with RA. For 160 TPLO cases per year, hospital cost when RA is performed decreased the cost by $12,864 per year up to increased cost by $1104 per year, depending on the requirements for systemic drugs and incidence/severity of anesthesia complications. The estimated fee charge per case for service necessary to reimburse the cost of a new ultrasound (US$25,000.00) and nerve locator (US$925.00) over their life span of 6 and 10 years, respectively, is US$26.62. Conclusions and clinical relevanceUltrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation confirmation can increase the anesthesia cost through use of specific equipment. However, in most cases, the anesthesia cost decreased as a result of decreased costs for pain management and treatment of complications.