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REGIONAL ANESTHESIA

Plantar Flexion Seems More Reliable than Dorsiflexion with Labat’s Sciatic Nerve Block: A Prospective, Randomized Comparison

Manuel Taboada, MD^*, Peter G. Atanassoff, MD, Jaime Rodríguez, MD, PhD^*, Joaquín Cortés, MD, PhD^*, Sabela Del Rio, MD^*, Juan Lagunilla, MD^*, Francisco Gude, MD^*, and Julián Álvarez, MD, PhD^*

*University of Santiago de Compostela, Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Spain; and Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut

Address correspondence and reprint requests to Manuel Taboada Muñiz, MD, Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Travesía da Choupana s/n, 15706 Santiago de Compostela (Spain). Address e-mail to manutabo{at}mixmail.com and manutabo@yahoo.es.

Labat’s classic approach to the sciatic nerve has not been able to show which motor response of the foot provides a more frequent rate of complete sensory and motor block. In this prospective, randomized, double-blind study, we compared plantar flexion with dorsiflexion with regard to onset time and efficacy of sciatic nerve block using the classic posterior approach. A total of 80 patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block after evoked plantar flexion (n = 40) or dorsiflexion (n = 40). Twenty milliliters of 0.75% ropivacaine was injected after the motor response was elicited at <0.5 mA. Success rate was defined as complete sensory and motor block in all sciatic nerve distributions associated with a pain-free surgery. Time required for onset of sensory and motor block of the foot was recorded. Success was more frequent after elicited plantar flexion (87.5%) than dorsiflexion (55%; P < 0.05). Onset of complete sensory and motor block of the foot was faster after elicited plantar flexion (10 ± 10 min and 13 ± 10 min, respectively) compared with dorsiflexion (20 ± 11 min and 24 ± 12 min; P < 0.05). We conclude that plantar flexion of the foot predicts a shorter onset time and a more frequent success rate than dorsiflexion with Labat’s classic posterior sciatic nerve block.

IMPLICATIONS: Plantar flexion of the foot during Labat’s classic posterior sciatic nerve block predicts a shorter onset time and more frequent success rate than dorsiflexion.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999