Document Detail


The effects of ultrasound guidance and neurostimulation on the minimum effective anesthetic volume of mepivacaine 1.5% required to block the sciatic nerve using the subgluteal approach.
MedLine Citation:
PMID:  19843807     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We tested the hypothesis that ultrasound (US) guidance may reduce the minimum effective anesthetic volume (MEAV(50)) of 1.5% mepivacaine required to block the sciatic nerve with a subgluteal approach compared with neurostimulation (NS). METHODS: After premedication and single-injection femoral nerve block, 60 patients undergoing knee arthroscopy were randomly allocated to receive a sciatic nerve block with either NS (n = 30) or US (n = 30). In the US group, the sciatic nerve was localized between the ischial tuberosity and the greater trochanter. In the NS group, the appropriate muscular response (foot plantar flexion or inversion) was elicited (1.5 mA, 2 Hz, 0.1 ms) and maintained to <or=0.5 mA. The volume of the injected local anesthetic was varied for consecutive patients based on an up-and-down method, according to the response of the previous patient. The initial volume was 12 mL. An independent observer evaluated the occurrence of complete loss of pinprick sensation and motor block: positive or negative responses within 20 min after the injection determined a 2-mL decrease or increase for the next patient, respectively. RESULTS: The mean MEAV(50) for sciatic nerve block was 12 mL (95% confidence interval [CI], 10-23 mL) in Group US and 19 mL (95% CI, 15-23 mL) in Group NS (P < 0.001). The effective dose in 95% of cases was 14 mL (95% CI, 12-17 mL) in Group US and 29 mL (95% CI, 25-40 mL) in Group NS (P = 0.008). CONCLUSIONS: US provided a 37% reduction in the MEAV(50) of 1.5% mepivacaine required to block the sciatic nerve compared with NS.
Authors:
Giorgio Danelli; Daniela Ghisi; Andrea Fanelli; Andrea Ortu; Elisa Moschini; Marco Berti; Stefanie Ziegler; Guido Fanelli
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  109     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-21     Completed Date:  2009-11-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1674-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, 43100 Parma, PR, Italy. gdanelli@ao.pr.i
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthetics, Local / administration & dosage*
Arthroscopy* / adverse effects
Dose-Response Relationship, Drug
Electric Stimulation*
Female
Femoral Nerve / drug effects
Humans
Knee Joint / innervation,  surgery*,  ultrasonography
Male
Mepivacaine / administration & dosage*
Middle Aged
Nerve Block*
Pain Measurement
Pain Threshold / drug effects
Pain, Postoperative / prevention & control
Sciatic Nerve / drug effects*,  ultrasonography*
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 96-88-8/Mepivacaine

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


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