title: Parasacral sciatic nerve block: does the elicited motor response predict the success rate?
abstract: BACKGROUND
  In this prospective, randomized, double-blind study, we compared the tibial and the peroneal evoked motor response with regard to efficacy of sciatic nerve block using the parasacral approach.
  
  
  METHODS
  Twenty-six ASA I-III patients scheduled for elective lower limb surgery were randomized to receive a parasacral sciatic block, using a nerve stimulator technique seeking either a tibial (n = 14) or peroneal (n = 12) motor response. After the evoked motor response was obtained, a solution of 10 mL 2% lidocaine with epinephrine and 10 mL 0.75% ropivacaine (actual final concentration of epinephrine, 1/160,000) was slowly injected through the needle. Sensory and motor blocks were assessed every 5 min for 30 min by an anesthesiologist blinded to the elicited motor response. If the block was not complete 30 min after injection of the local anesthetics, it was considered as failed, and general anesthesia was supplemented.
  
  
  RESULTS
  Time to perform the block and level of minimal and maximal stimulation were not different between groups. The success rate of complete block was significantly higher in the tibial compared to the peroneal group (11 of 14 vs 2 of 12; P = 0.002).
  
  
  CONCLUSIONS
  Eliciting a tibial motor response predicts a higher success rate than eliciting a peroneal motor response with parasacral sciatic nerve block.
authors.affiliation: Department of Anesthesiology, CHU-Brugmann--Huderf, Brussels, Belgium. benedicte.hagon@chu-brugmann.be
authors.forename: Bénédicte S
authors.initials: BS
authors.lastname: Hagon
authors.forename: Omar
authors.initials: O
authors.lastname: Itani
authors.forename: Jawad Hosseini
authors.initials: JH
authors.lastname: Bidgoli
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Van der Linden
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D019054:Evoked Potentials, Motor / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012447:Sacrum / Q000187:drug effects / Q000502:physiology; D012584:Sciatic Nerve / Q000187:drug effects / Q000502:physiology*
chemical_list: D000779:Anesthetics, Local