Summary
This study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200 000 adrenaline was injected in a dose of 2 mg.kg Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p < 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.
Pelvic brachytherapy presents the anaesthetist with numerous challenges. Patients vary from highly distressed young adults, to the elderly with coincidental disease severe enough to preclude surgery. The painful radioactive implants remain in place for a number of days. Treatment in isolated rooms reduces radiation exposure to staff, but makes close postoperative monitoring difficult, so the analgesic technique should involve minimum risk to the patient. Although there is very little published evidence of specific analgesic techniques in this area, knowledge of these problems allows the anaesthetist to select appropriate systemic analgesics and regional blocks to provide safe and effective pain relief.
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