Continuous Popliteal Sciatic Nerve Block Versus Single Injection Nerve Block for Ankle Fracture Surgery

Ding, David Y.; Manoli, Arthur; Galos, David K.; Jain, Sudheer; Tejwani, Nirmal C.

doi:10.1097/bot.0000000000000374

Cited by 64 publications

(40 citation statements)

References 24 publications

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“…This may be superior to other studies that reported a displacement rate of 40–50% of sciatic catheters when placed perpendicular to the nerve . Some studies have reported fewer displacements but they did not systematically assess catheter position or function , whereas others consistently tested for catheter function by using loss of cold sensation . By comparison, we found loss of cold sensation corresponding to dermatomes of the common peroneal nerve in 14 out of 16 catheters (88%) after physical exercises and repeat local anaesthetic injection.…”

Section: Discussioncontrasting

confidence: 77%

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Initial placement and secondary displacement of a new suture‐method catheter for sciatic nerve block in healthy volunteers: a randomised, double‐blind pilot study

et al. 2017

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We performed a randomised double-blind pilot study in 16 healthy volunteers to investigate the success rate for placing a new suture-method catheter for sciatic nerve block. A catheter was inserted into both legs of volunteers and each was randomly allocated to receive 15 ml lidocaine 2% through the catheter in one leg and 15 ml saline in the other leg. Successful placement of the catheter was defined as a 20% decrease in maximum voluntary isometric contraction for dorsiflexion of the ankle. Secondary outcomes were maximum voluntary isometric contraction for plantar flexion at the ankle, surface electromyography and cold sensation. After return of motor and sensory function, volunteers performed standardised physical exercises; injection of the same study medication was repeated in the same leg and followed by motor and sensory assessments. Fifteen of 16 (94%; 95%CI 72-99%) initial catheter placements were successful. The reduction in maximum voluntary isometric contraction and surface electromyography affected the peroneal nerve more often than the tibial nerve. Eleven of 15 (73%; 95%CI 54-96%) catheters remained functional with motor and sensory block after physical exercise, and the maximal displacement was 5 mm. Catheters with secondary block failure were displaced between 6 and 10 mm. One catheter was displaced 1.8 mm that resulted in a decrease in maximum voluntary isometric contraction of less than 20%. After repeat test injection, 14 of the 16 volunteers had loss of cold sensation. Neither motor nor sensory functions were affected in the legs injected with placebo. We conclude that the suture-method catheter can be placed with a high success rate, but that physical exercise may cause displacement.

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Section: Discussioncontrasting

confidence: 77%

“…The low volumes of local anaesthetic used in this study might increase the possibility of failed block due to imprecise primary placement or secondary displacement. However, despite using a lower volume than previous studies using ultrasound‐guided placement of sciatic catheters (20–40 ml) , we still achieved a high success rate.…”

Section: Discussioncontrasting

confidence: 60%

Initial placement and secondary displacement of a new suture‐method catheter for sciatic nerve block in healthy volunteers: a randomised, double‐blind pilot study

et al. 2017

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“…Over the first 72 hours, patients in the CPNB group took significantly fewer oral narcotics and had lower pain scores. 275 Another study of patients undergoing open fixation for calcaneal fractures compared controls (no regional blocks) versus a single-shot block or against a continuous popliteal nerve block. In the 36 hours after surgery, the patients in the continuous block used significantly fewer IV narcotics than did the other 2 groups.…”

Section: Recommendationsmentioning

confidence: 99%

Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury

Hsu¹,

Mir

Wally³

et al. 2019

Journal of Orthopaedic Trauma

177

178

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“…Studies on peripheral nerve block in limb surgery raise concerns about ‘rebound pain’ when the effects of the block wear off . This potentially outweighs the benefits.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

et al. 2017

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Summary Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients’ expectations and experiences by means of semi‐structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre‐emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.

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Continuous Popliteal Sciatic Nerve Block Versus Single Injection Nerve Block for Ankle Fracture Surgery

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 64 publications

References 24 publications

Initial placement and secondary displacement of a new suture‐method catheter for sciatic nerve block in healthy volunteers: a randomised, double‐blind pilot study

Initial placement and secondary displacement of a new suture‐method catheter for sciatic nerve block in healthy volunteers: a randomised, double‐blind pilot study

Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

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