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Ultrasound guidance for sciatic nerve blocks shown to have a 99% success rate
The investigators found no needle paresthesia, neurologic deficits or intravascular injections.
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VANCOUVER, British Columbia — Recent research indicates that using ultrasound guidance for the placement of sciatic nerve block injections at the popliteal fossa is effective.
“Ultrasound guidance is a safe and reliable method for needle localization during popliteal fossa blocks,” Kenneth J. Hunt, MD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society.
“The location of the needle within the compartment is adequate. It does not necessarily need to stimulate or be next to the sciatic nerve. Regional block teams can be an effective way to get these blocks done efficiently and perhaps save time and money, and this may be a potential mode of primary anesthesia,” he said.
Bupivacaine injections
Hunt and his colleagues prospectively studied 200 consecutive patients undergoing various foot and ankle procedures who received a single or continuous sciatic nerve block injection of 0.25% bupivacaine placed at the popliteal fossa using ultrasound guidance.
They evaluated the patients preoperatively, immediately postoperative and 10 to 14 days after surgery.
They defined block failure as an incomplete sensory blockade at examination, and noted any instances of needle paresthesia, vessel puncture, injection site infection, or residual neurologic deficits.
Success rate
“Our success rate was about 99%,” Hunt said. “We only had one failure and that was in the catheter group. That patient was re-blocked in the postoperative area, had excellent pain relief and was discharged home with a catheter.”
In addition, the investigators found no needle paresthesia, neurologic deficits, vessel punctures or intravascular injections.
Judith W. Smith, MD, asked from the audience about the duration of the sciatic nerve block and the potential of re-blocking patients.
“The single-shot block lasts between 18 and 24 hours,” Hunt said. “[For] the catheters, the caregivers were given instructions to remove the catheter at about 48 to 60 hours which is the extent of the effectiveness. In this series, we did not have anyone have a re-admission and then repeated block.”
For more information:
- Kenneth J. Hunt, MD, can be reached at Stanford University Department of Orthopaedics, 450 Broadway St., Pavilion C, MC 6342, Redwood City CA 94063; 801-835-9590; e-mail: kenneth.hunt@live.com.
- Judith W. Smith, MD, can be reached at the Ferrell Duncan Clinic, Inc., 3555 S. National Ave., Ste. 200, Springfield, MO 65807; 417-875-3800. Neither source has a direct financial interest in any products or companies mentioned in this article.
Reference:
- Hunt KJ, Beals T, Nichish F, et al. Analgesia for foot and ankle surgery with sciatic nerve block using ultrasound guidance: A prospective study of 200 patients. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.