Sciatic lateral popliteal block with clonidine alone or clonidine plus 0.2% ropivacaine: effect on the intra-and postoperative analgesia for lower extremity surgery in children: a randomized prospective controlled study

Abstract

BackgroundThe effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most of the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia when used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population, there are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not definite in this group of patients. The evidence concerning perineural administration of clonidine is so far inconclusive in children, as different types and volume of local anesthetic agents have been used in these studies. Moreover, the efficacy of regional anesthesia is largely affected by the operator's technique, accuracy and severity of operation.MethodsThe use of clonidine alone or combined with 0.2% ropivacaine for effective analgesia after mild to moderate painful foot surgery was assessed in 66 children, after combined sciatic lateral popliteal block (SLPB) plus femoral block. The patients were randomly assigned into three groups to receive placebo, clonidine, and clonidine plus ropivacaine. Time to first analgesic request in the groups was analyzed by using Kaplan-Meier and the log-rank test (mean time, median time, 95% CI).ResultsIn our study, clonidine administered alone in the SLPB seems promising, maintaining intraoperatively the hemodynamic parameters SAP, DAP, HR to the lower normal values so that no patient needed nalbuphine under 0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for a median time of 6 hours. In addition, clonidine administered as adjuvant enhances ropivacaine's analgesic effect for the first postoperative day in the majority of children (p = 0.001). Clonidine and clonidine plus ropivacaine groups also didn’t demonstrate PONV, motor blockade, and moreover, the parents of children expressed their satisfaction with the excellent perioperative management of their children, with satisfaction score 9.74 ± 0.45 and 9.73 ± 0.70 respectively. On the contrary all the patients in the control group required rescue nalbuphine in the recovery room, and postoperatively, along with high incidence of PONV, and the parents of children reported a low satisfaction score (7.50 ± 0.70).ConclusionsClonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the SLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects.Trial registrationClinicalTrials.gov, ISRCTN90832436, (ref: CCT-NAPN-20886).

Use of a perineural coiled catheter at the sciatic nerve in dogs after tibial plateau levelling osteotomy – preliminary observations

“…At Day 1, mobility based on the modified Bromage score was present in all but three dogs of the ropivacaine group. In humans, early mobility was present with a continuous block of the sciatic nerve using ropivacaine 0.2% in adults while a sensory block without motor block was provided with ropivacaine 0.25% in children (Casati et al 2004;Petroheilou et al 2012). In our study, the assessment of weight bearing as a criterion to evaluate the extent of motor block might not always be conclusive as the bandage applied to the operated leg of the dogs might have influenced the motor function.…”

“…; Petroheilou et al . ). In our study, the assessment of weight bearing as a criterion to evaluate the extent of motor block might not always be conclusive as the bandage applied to the operated leg of the dogs might have influenced the motor function.…”

Lower limb surgeries under combined femoral and sciatic nerve block

“…Cardiorespiratory parameters such as heart rate, systolic blood pressure, diastolic blood pressure, RR, oxygen percent saturation remain stable and comparable in both groups intraoperatively. Studies conducted by Petroheilou et al .,[ 15 ] Casati et al .,[ 16 ] Theodosiadis et al .,[ 17 ] Fanelli et al .,[ 18 ] Baddoo[ 6 ] using ropivacaine in lower limb peripheral nerve block also observed no changes in cardiorespiratory parameter perioperatively.…”

Sciatic Nerve Block in the Popliteal Fossa Using Lateral Approach in an Infant with Goldenhar Syndrome

“…This choice moreover, allowed us to use the LMA to secure the airway, offering many advantages over tracheal intubation, such as extubation and smooth emergence from anesthesia. [22] Sciatic nerve block for foot and limb surgeries in children is widely used [23,24], generally through the posterior approach. [25,26] We performed the block using a nerve stimulator technique, as we have not enough experience with ultrasound.…”