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ANALGESIA

A Modified Mid-Femoral Approach to the Sciatic Nerve Block: A Correlation Between Evoked Motor Response and Sensory Block

From the Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France.

Address correspondence and reprint requests to: Dr. Antoine Pianezza, MD, Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Rangueil Hospital, Orthopedic section, 1, Avenue Jean Poulhès, Toulouse, France. Address e-mail to a.pianezza{at}wanadoo.fr.

Abstract

BACKGROUND: The lateral sciatic mid-femoral block (LSMF), proved to be reliable, safe, and effective on both branches of the sciatic nerve with a single injection. However, we do not know which component of the sciatic nerve (the tibial [T] or the common peroneal [CP]) produces a better success rate when performing a LSMF with a single injection technique. In this prospective study we compared the success rate of the T motor response with the CP motor response.

METHODS: Ninety-five patients undergoing ankle or foot surgery were enrolled. Thirty milliliters of 0.475% ropivacaine was injected at the first evoked motor response, either T or CP, with a minimal intensity between 0.3 and 0.5 mA.

RESULTS: Seventy-two patients were included in group T and 23 in group CP. The block was considered a success when a complete sensory block of the sciatic nerve was obtained. The success rate was 90% (65) for the T response and 70% (16) for the CP response (P < 0.05).Time to perform the block (CP: 4.5 ± 3 min vs T: 4.5 ± 4 min; P = NS) as well as sensory and motor onset times were not significantly different between groups. No complications were observed in either group.

CONCLUSION: We conclude that the evoked motor response of the T branch is associated with a higher success rate than a CP response using the modified LSMF block.

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