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Anesth Analg 2008; 106:1553-1558
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181684b42
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REGIONAL ANESTHESIA

Combined Ultrasound and Neurostimulation Guidance for Popliteal Sciatic Nerve Block: A Prospective, Randomized Comparison with Neurostimulation Alone

Eric Dufour, MD*, Patrick Quennesson, MD{dagger}, Anne Laure Van Robais, MD*, Françoise Ledon, MD{ddagger}, Pierre-Antoine Laloë, MD*, Ngai Liu, MD*, and Marc Fischler, MD*

From the *Department of Anesthesiology, Hôpital Foch, Suresnes, France; Departments of {dagger}Anesthesiology, and {ddagger}Surgery, Clinique La Montagne, Courbevoie, France.

Address correspondence and reprint requests to Prof. M. Fischler, Department of Anesthesiology, Hôpital Foch, 40 rue Worth, 92151 Suresnes, France. Address e-mail to m.fischler{at}hopital-foch.org.

BACKGROUND: Ultrasound imaging, an effective tool to localize peripheral nerves, may facilitate block performance. However, its usefulness during popliteal sciatic nerve block has not been assessed.

METHODS: In this prospective, randomized, patient-blinded study, we compared the block time (as the primary end-point) of a popliteal sciatic nerve block with double-injection performed using anatomical landmarks and neurostimulation (NS group; n = 30) versus combined ultrasound and neurostimulation guidance (US-NS group; n = 30). Each block procedure was performed by a single operator. Correct needle placement was defined by a minimal stimulating current ≤0.5 mA, or, in the US-NS group, by mobilization of the nerve by the needle shaft even if the minimal stimulating current >0.5 mA. Ten milliliter levobupivacaine 0.5% was administered separately on the tibial and common peroneal nerves without needle adjustment to improve the spread of anesthetic in the US-NS group. All procedures were video-recorded, and a maximum of 7 min was allowed to perform the block. Successful block was defined as complete loss of cold sensation in the sciatic distribution and an inability to perform a plantar and dorsal flexion of the foot at 30 min.

RESULTS: Five patients in the NS group and three in US-NS group were excluded from the study for prolonged procedure. Block time was not significantly different between groups. The number of needle passes was lower only for the detection of the first nerve in the US-NS group (1 [1–2] vs 2 [1–6]; P < 0.01). A greater success rate was observed at 30 min in the US-NS group (65% vs 16%; P < 0.001).

CONCLUSIONS: Combined ultrasound and neurostimulation guidance does not decrease block time but increases the success rate of popliteal sciatic nerve block observed at 30 min.






Lippincott, Williams & Wilkins 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 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.