Subparaneural Versus Circumferential Extraneural Injection at the Bifurcation Level in Ultrasound-Guided Popliteal Sciatic Nerve Blocks
| Autor: | B. Abbal, Sophie Bringuier, Xavier Capdevila, Didier Morau, Olivier Choquet, Guillaume Brault Noble |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Randomization Adolescent medicine.drug_class Mepivacaine Extraneural Injections Young Adult Double-Blind Method medicine Humans Prospective Studies Anesthetics Local Tibial nerve Ultrasonography Interventional Aged Local anesthetic business.industry Nerve Block General Medicine Middle Aged Sciatic Nerve Confidence interval Surgery Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Female Sciatic nerve Ankle business medicine.drug |
| Zdroj: | Regional Anesthesia and Pain Medicine. 39:306-311 |
| ISSN: | 1098-7339 |
| DOI: | 10.1097/aap.0000000000000095 |
| Popis: | Background The ideal spread of local anesthetic for effective, rapid, and safe sciatic nerve block is debated. We hypothesized that subparaneural ultrasound-guided injection results in faster onset and has a better success rate than extraneural circumferential spread. Methods Patients undergoing elective tibial, foot, and ankle surgery with popliteal sciatic nerve blocks were prospectively enrolled. After randomization, the needle tip position was adjusted to ensure circumferential extraneural or subparaneural spread; 0.3 mL/kg of mepivacaine 10 mg/mL was injected. Post hoc video analysis was used to group the patients according to extraneural, subparaneural, and unintentional intraepineural spread. Results There were 26 (43.3%) patients in the subparaneural group and 22 (36.7%) in the extraneural group. Block onset time was shorter in the subparaneural group than in the extraneural group (11 [3–21] minutes; mean [95% confidence interval], 11 [8.97–13.02] minutes and 17 [6–30] minutes; mean [95% confidence interval] 18.37 [14.17–22.57] minutes, respectively; P = 0.002). The duration of sensory blockade increased (397 [178–505] minutes vs 265 [113–525] minutes; P = 0.04). The success rate of the block also increased. Unintentional intraepineural injection occurred in 8% of patients (3 patients in the subparaneural group and 1 patient in the extraneural group; NS). Block onset time was shorter than for the subparaneural and extraneural groups (6 [3–12] minutes, 12 [3–21] minutes, and 18 [6–30] minutes; P = 0.01). Conclusions A subparaneural injection accelerated the onset time and increased the duration of tibial nerve sensory blockade compared with circumferential extraneural injection. With unintentional intraepineural spread, the onset time was significantly shorter than for the other groups. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|