A Randomized Comparison Between Bifurcation and Prebifurcation Subparaneural Popliteal Sciatic Nerve Blocks

Tran, De Q.H.; González, Andrea P.; Bernucci, Francisca; Pham, Kevin; Finlayson, Roderick J.

doi:10.1213/ane.0b013e31828a73be

Cited by 26 publications

(39 citation statements)

References 11 publications

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“…Again, the subparaneural technique yielded a higher success rate (100% vs 73%; p=0.006) and a 35% reduction in onset time. Tran et al 199 then set out to compare subparaneural LA injection at or proximal to the sciatic neural bifurcation: both techniques displayed similar success rates (85%–88%) and onset times. Subsequently, the same investigators compared single-subparaneural to triple-subparaneural injection techniques: again, no intergroup differences were found in terms of success rate (92%).…”

Section: Nerve Blocks Of the Sacral Plexusmentioning

confidence: 99%

Lower extremity regional anesthesia: essentials of our current understanding

Tran

Salinas

Benzon

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

134

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The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

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Section: Nerve Blocks Of the Sacral Plexusmentioning

confidence: 99%

Lower extremity regional anesthesia: essentials of our current understanding

Tran

Salinas

Benzon

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

134

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“…[5][6][7] Depending on where the needle tip is inserted and the spread of LA solution, significant differences in onset time and duration of sensory and motor blockades have been reported. [8][9][10][11][12][13] The recent literature highlights the importance of obtaining an extraneural concentric distribution of LA around the sciatic nerve 1,14,15 or an extraneural injection surrounding both tibial and peroneal nerves distal to the bifurcation. 12,13,16 In 2 studies, a proximal injection below the paraneural sheath seemed superior to an extraneural distal injection around both separate tibial and peroneal nerves.…”

mentioning

confidence: 99%

“…12,13,16 In 2 studies, a proximal injection below the paraneural sheath seemed superior to an extraneural distal injection around both separate tibial and peroneal nerves. 8,10 Only 1 study focused on LA volume, 11 compared extraneural circumferential spread with subparaneural (subfascial) spread of LA solution around the sciatic nerve bifurcation. On one hand, the pharmacodynamic importance of the common paraneural sheath is questionable.…”

mentioning

confidence: 99%

“…On one hand, the pharmacodynamic importance of the common paraneural sheath is questionable. 17,18 On the other hand, although unintentional intraepineural injection has now been reported in 6% to 17% of ultrasound-guided peripheral nerve blocks, 8,19,20 no study has reported the block pharmacodynamic profile related to unintentional intraepineural injections. In this randomized double-blind study, we hypothesized that a subparaneural ultrasound-guided injection of LA results in faster onset and has a better success rate than extraneural circumferential spread of LA around the entire sciatic nerve at the bifurcation level.…”

mentioning

confidence: 99%

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Subparaneural Versus Circumferential Extraneural Injection at the Bifurcation Level in Ultrasound-Guided Popliteal Sciatic Nerve Blocks

Choquet

Brault-Noble

Abbal

et al. 2014

Regional Anesthesia and Pain Medicine

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“…Due to lateral location of the common peroneal nerve it was stimulated often in the lateral approach. Irrespective of the nerve stimulated (Tibial or peroneal) the field of block is found to be complete sciatic nerve distribution area 12 .…”

Section: Discussionmentioning

confidence: 89%

A Comparison of Ease of Nerve Localization and Complications Between Posterior and Lateral Approaches of Popliteal Block

Radhakrishnan¹,

R²,

Sethuraman³

2015

jemds

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BACKGROUND:Popliteal block is a rarely performed regional anaesthetic technique because it requires placing the patient in prone position which is technically difficult. A recent technique called intertendinous or lateral approach which is done laterally can be done with patient in supine position itself. In this study, we have compared ease of nerve localization and complications between posterior and lateral approaches of Popliteal block. METHODS: 120 patients undergoing foot and ankle surgery were randomized to receive the block using either the posterior (n = 60) or the lateral approach (n = 60). With both techniques, 30mL of 1% alkalinized (by adding 1.5ml of 10% sodium bicarbonate) lignocaine with 1:200,000 epinephrine were injected under nerve stimulation guidance. RESULTS: There were no differences in onset and duration of block between two techniques. The Posterior approach was associated with significant incidence of vascular puncture (10%) but lateral approach though technically difficult was safer with nil incidence of vascular puncture. CONCLUSIONS: Although, the lateral approach was technically difficult requiring more attempts (P value < 0.05) was safer, with no incidence of vascular puncture. KEYWORDS: Popliteal Block; Intertendinous Approach; Lignocaine; Nerve Stimulation; Vascular Puncture. INTRODUCTION:Sciatic nerve block in the popliteal fossa (Popliteal block) is one of the anesthetic techniques used for lower extremity surgery. Compared to spinal anesthesia it has very less complications. 1 it results in adequate block for ankle and foot surgeries, carries no risk of hemodynamic changes, post dural puncture headache and provides good postoperative analgesia. Despite these potential advantages, popliteal block is not often administered; reasons include inadequate exposure, training and a highly unpredictable success rate 2 of the block.The most frequently used technique for popliteal block is the classical or posterior approach, where it has a disadvantage of placing the patient in prone position 3 but the newer lateral or intertendinous. 4 approach is done with supine position and is more patient friendly. In this study we are comparing the two techniques in respect to ease of administration, onset and duration of block and complications.

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A Randomized Comparison Between Bifurcation and Prebifurcation Subparaneural Popliteal Sciatic Nerve Blocks

Cited by 26 publications

References 11 publications

Lower extremity regional anesthesia: essentials of our current understanding

Lower extremity regional anesthesia: essentials of our current understanding

Subparaneural Versus Circumferential Extraneural Injection at the Bifurcation Level in Ultrasound-Guided Popliteal Sciatic Nerve Blocks

A Comparison of Ease of Nerve Localization and Complications Between Posterior and Lateral Approaches of Popliteal Block

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