Document Detail

Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial.
MedLine Citation:
PMID:  19920423     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES.
METHODS: Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot and/or ankle surgery were randomly assigned to either the ES with a stimulating catheter or US-guided technique with a nonstimulating catheter. The primary end point was catheter insertion duration (in minutes) starting when the US transducer (US group) or catheter-placement needle (ES group) first touched the patient and ending when the catheter-placement needle was removed after catheter insertion.
RESULTS: All US-guided catheters were placed per protocol (n = 20), whereas only 80% of stimulation-guided catheters could be placed per protocol (n = 20, P = 0.106). All catheters placed per protocol in both groups resulted in a successful surgical block. Perineural catheters placed by US took a median (10th-90th percentile) of 5.0 min (3.9-11.1 min) compared with 10.0 min (2.0-15.0 min) for stimulation (P = 0.034). Subjects in the US group experienced less pain during catheter placement, scoring discomfort a median of 0 (0.0-2.1) compared with 2.0 (0.0-5.0) for the stimulation group (P = 0.005) on a numeric rating scale of 0 to 10.
CONCLUSIONS: Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.
Edward R Mariano; Gloria S Cheng; Lynna P Choy; Vanessa J Loland; Richard H Bellars; Navparkash S Sandhu; Michael L Bishop; Daniel K Lee; Rosalita C Maldonado; Brian M Ilfeld
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  34     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-11-20     Completed Date:  2010-01-27     Revised Date:  2011-04-06    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  480-5     Citation Subset:  IM    
Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, CA, USA.
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MeSH Terms
Ankle / surgery
Catheterization* / adverse effects
Electric Stimulation* / adverse effects
Foot / surgery
Middle Aged
Muscle Contraction
Nerve Block / methods*
Pain / etiology
Pain Measurement
Patient Satisfaction
Sciatic Nerve / ultrasonography*
Time Factors
Ultrasonography, Interventional* / adverse effects
Grant Support
Comment In:
Reg Anesth Pain Med. 2011 Jan-Feb;36(1):88   [PMID:  21169759 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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