The concept of protective nerve stimulation for ultrasound guided nerve blocks

Ertmer, Martin; Klotz, Edda; Birnbaum, Jürgen

doi:10.1016/j.mehy.2017.08.018

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…Tibial and foot surgeries, often complex and intricate, require effective postoperative pain management to enhance patient recovery and satisfaction. The challenges in managing postoperative wound pain in these surgeries are significant due to the complex nerve supply and the need for early mobilization 25,26 . Sciatic nerve block has emerged as a crucial technique in managing postoperative wound pain for lower limb surgeries.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Yu,

Wang,

Jiang

et al. 2023

International Wound Journal

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This systematic review and meta‐analysis evaluate the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed‐effect and random‐effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82–10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve‐related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = −8.57; 95% CI: −11.27 to −5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound‐guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Yu,

Wang,

Jiang

et al. 2023

International Wound Journal

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Currently, US has played an important role in PNBs due to its portability, repeatability, noninvasion, and nonradiation, although its use requires a lot of experience, anatomical knowledge, and practical skills. 10 US can visualize the anatomical structure underlying the probe on the display screen, including both normal and abnormal structures, 11,12 and visualize the trajectory and direction of the needle insertion. 13 With real-time imaging of the local anesthetic injection and its relationship with the target nerve, the anesthesiologist can maximize the success and speed of the nerve blocks using the fascial plane or sheath that contains the local anesthetic solution.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Single‐Center Comparative Analysis of Ultrasound‐Guided Versus Non‐ultrasound‐Guided Nerve Blocks in Extremity Surgeries

Zhang

et al. 2021

J of Ultrasound Medicine

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Objectives Although ultrasound‐guided peripheral nerve blocks have become increasingly popular, it is arguable at present whether ultrasound guidance is a necessary tool for peripheral nerve blocks. The purpose of this study was to assess the significance of ultrasound‐guided peripheral nerve blocks in reducing complications. Methods From January 2013 to January 2019, 17,823 patients who underwent peripheral nerve blocks with/without ultrasound guidance were reviewed, recording data on their age, sex, height, weight, American Society of Anesthesiologists, block type, operation type, operation duration, and complications. The patients were divided into 2 groups: 9372 cases with ultrasound guidance (US Group) and 8451 cases without ultrasound guidance (No‐US Group). To control selection bias, a total of 16,236 patients were finally included in this study after 1:1 propensity score matching, including 8118 cases in the US Group and 8118 cases in the No‐US Group. Outcome measures included local anesthetic systemic toxicity (LAST), nerve injury, incomplete block anesthesia (IBA), local hematoma, and infection at the block site. Results Baseline characteristics of patients were similar between the two groups (P >.05, respectively). Our study revealed that the incidence of infection was similar between the two groups (P >.05). However, the incidences of LAST, nerve injury, IBA, and local hematoma in the US Group were significantly lower than those in the No‐US Group (P <.05, respectively). Conclusions Our findings suggest that ultrasound‐guided peripheral nerve blocks are associated with fewer complications and higher success rates, compared with the paresthesia approach.

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“…If a response is still present at 0.5 mA, the needle position on the screen is verified and/or withdrawn, and the process repeated. The use of both monitors in this way has been termed 'dual guidance' or 'protective nerve stimulation' [41].…”

Section: Nerve Stimulation As a Monitor For Nerve Block Safetymentioning

confidence: 99%

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Gadsden

2021

Anaesthesia

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Summary With the widespread use of ultrasound for localising nerves during peripheral nerve blockade, the value of electrical nerve stimulation of evoked motor responses has been questioned. Studies continue to show that, compared with nerve stimulation, ultrasound guidance alone leads to: significantly improved block success; decreased need for rescue analgesia; decreased procedural pain; and lower rates of vascular puncture. Nerve stimulation combined with ultrasound does also not appear to improve block success rates, apart from those blocks where the nerves are challenging to view, such as the obturator nerve. The role of nerve stimulation has changed in the last 15 years from a technique to locate nerves to that of an adjunct to ultrasound. Nerve stimulation can serve as a monitor against needle‐nerve contact and may be useful in avoiding nerves that are in the needle trajectory during specific ultrasound guided techniques. Nerve stimulation is also a useful adjunct in teaching novices ultrasound‐guided regional anaesthesia, especially when the position and or appearance of nerves may be variable. In this review, the changing role of nerve stimulation in contemporary regional anaesthetic practice is presented and discussed.

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The concept of protective nerve stimulation for ultrasound guided nerve blocks

Cited by 7 publications

References 10 publications

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Retrospective Single‐Center Comparative Analysis of Ultrasound‐Guided Versus Non‐ultrasound‐Guided Nerve Blocks in Extremity Surgeries

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

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