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Sciatic Nerve Block (sciatic + nerve_block)
Kinds of Sciatic Nerve Block Selected AbstractsMajor complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009V. COMPÈRE Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post-operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post-operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre-operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th,75th percentiles]. Results: A total of 400 patients were included in the study during a 2-year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications. [source] Ultra-sound guided sciatic nerve block combined with lumbar plexus block for infra-inguinal artery bypass graft surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2008Y. Asakura No abstract is available for this article. [source] Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006A. Casati Background:, We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:, The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:, Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 , vs. 67 ,; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 , vs. 55 ,; P= 0.0005). Conclusions:, Direct costs of continuous sciatic nerve block ranged from 55 to 75 ,. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [source] Anterior sciatic nerve block , new landmarks and clinical experienceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005M. Wiegel Background: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. Methods: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. Results: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5,14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. Conclusion: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement. [source] Double-blind comparison of ropivacaine 7.5 mg mL,1 for sciatic nerve block. (Ninewells Hospital and Medical School, Dundee, United Kingdom) British J Anesh.PAIN PRACTICE, Issue 4 20012001;26:20 Two groups of 12 patients had a sciatic nerve block performed with 20 mL of either ropivacaine 7.5 mg mL,1 or bupivacaine 5 mg mL,1. There was no statistically significant difference in the mean time to onset of complete anesthesia of the foot or to the first request for postoperative analgesia. The quality of the block was the same in each group. Although there is no statistically significant difference in the mean time to peak plasma concentrations the mean peak concentration of ropivacaine was significantly higher than that of bupivacaine. There were no signs of systemic local anesthetic toxicity in any patient in either group. [source] Addition of sodium bicarbonate to lidocaine decreases the duration of peripheral nerve block in rat. (Harvard Medical School, Boston, MA) Anesthesiology 2000;93:1045,1052.PAIN PRACTICE, Issue 2 2001Catherine J. Sinnott This study evaluated the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block. The study was broken up into two parts. Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. The study concluded that with 1% commercial lidocaine without epinephrine, sodium bicarbonate decreases the degree and duration of the block. However, in solutions with epinephrine, sodium bicarbonate hastens onset, without effecting degree or duration. Comment by Octavio Calvillo, M.D., Ph.D. There is evidence that adding sodium bicarbonate to lidocaine without epinephrine improves the quality of epidural block, whereas adding sodium bicarbonate to lidocaine with epinephrine does not. The addition of 8.4% sodium bicarbonate to 2% lidocaine without epinephrine was shown to decrease the onset time and enhance the depth of the epidural block. When bicarbonate was added to 2% lidocaine with epinephrine neither onset time nor depth of the epidural block was affected. Most investigators have used epidural block as their paradigm. The authors in this study used the sciatic nerve block of the rat. [source] The biceps femoris muscle as a landmark for performing the popliteal sciatic nerve block using ultrasound guidance in pediatric patientsPEDIATRIC ANESTHESIA, Issue 10 2010Blaine R. Miller No abstract is available for this article. [source] Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve blockANAESTHESIA, Issue 6 2009G. Danelli Summary In this prospective, randomised, observer-blinded study we evaluated whether ultrasound guidance can shorten the onset time of popliteal sciatic nerve block as compared to nerve stimulation with a multiple injection technique. Forty-four ASA I,III patients undergoing posterior popliteal sciatic nerve block with 20 ml of 0.75% ropivacaine were randomly allocated to nerve stimulation or ultrasound guided nerve block. A blinded observer recorded onset of sensory and motor blocks, success rates, the need for fentanyl intra-operatively, the requirement for general anaesthesia, procedure-related pain, patient satisfaction and side-effects. Onset times for sensory and motor blocks were comparable. The success rate was 100% for ultrasound guided vs 82% for nerve stimulation (p = 0.116). Ultrasound guidance reduced needle redirections (p = 0.01), were associated with less procedural pain (p = 0.002) and required less time to perform (p = 0.002). Ultrasound guidance reduced the time needed for block performance and procedural pain. [source] Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009V. COMPÈRE Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post-operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post-operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre-operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th,75th percentiles]. Results: A total of 400 patients were included in the study during a 2-year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications. [source] Anterior sciatic nerve block , new landmarks and clinical experienceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005M. Wiegel Background: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. Methods: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. Results: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5,14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. Conclusion: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement. [source] Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study,ANAESTHESIA, Issue 8 2009M. J. Fredrickson Summary Little data exists regarding the frequency of neurological complications following ultrasound guided peripheral nerve blockade. Therefore, we studied single injection and continuous ultrasound guided interscalene, supraclavicular, infraclavicular, femoral and sciatic nerve blocks in patients undergoing orthopaedic extremity surgery. All patients were contacted during postoperative weeks 2,4 and questioned for numbness or altered sensation anywhere in the involved extremity, and pain or weakness unrelated to surgery. The presumed aetiology of symptoms was based on the collective agreement of principal investigator, primary surgeon and a neurologist. Multivariate analysis was performed for characteristics potentially important in the causation of neurological complications. Of 1010 consecutive blocks, successful follow up between weeks 2 and 4 occurred in 98.6%. New, all-cause, neurological symptoms were present in 56/690 blocks (8.2%) at day 10, 37/1010 (3.7%) at 1 month and 6/1010 (0.6%) at 6 months. Most symptoms were due to causes unrelated to the block. Of 452 patients directly questioned at the time of the block, new neurological symptoms were more common in patients who experienced procedure-induced paraesthesia (odds ratio = 1.7, p = 0.029). The postoperative neurological symptom rate in this series is very similar to those previously reported following traditional techniques. [source] Hands-free leg support for sciatic nerve blocksANAESTHESIA, Issue 5 2009J. Dingley No abstract is available for this article. [source] | ||||||||||