title: A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa.
abstract: The direct visualisation of nerves and adjacent anatomical structures may make ultrasonography the preferred method for nerve localisation. In this prospective randomised study, we investigated whether, for distal sciatic nerve block in the popliteal fossa, an ultrasound guided technique would result in the use of less local anaesthetic without changing block characteristics and quality. Using electrical nerve stimulation or ultrasound guidance, the nerve was identified in two groups of 20 patients scheduled for lower limb surgery. Hereafter lignocaine 1.5% with adrenaline 5 microg/ml was injected. The attending anaesthesiologist assessed the injected volume. Significantly less local anaesthetic was injected in the ultrasound group compared to the nerve stimulation group (17 vs. 37 ml, P < 0.001), while the overall success rate was increased (100% vs. 75%; P = 0.017). We conclude that the use of ultrasound localisation for distal sciatic nerve block in the popliteal fossa reduces the required dose of local anaesthetic significantly, and is associated with a higher success rate compared to nerve stimulation without changing block characteristics.
authors.affiliation: Department ofAnaesthesiology, Radboud University Medical Centre and Bernhoven Hospital, Nijmegen, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: van Geffen
authors.forename: E
authors.initials: E
authors.lastname: van den Broek
authors.forename: G J J
authors.initials: GJ
authors.lastname: Braak
authors.forename: J L P
authors.initials: JL
authors.lastname: Giele
authors.forename: M J
authors.initials: MJ
authors.lastname: Gielen
authors.forename: G J
authors.initials: GJ
authors.lastname: Scheffer
mesh_terms: D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D000779:Anesthetics, Local / Q000008:administration & dosage; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D009407:Nerve Block / Q000295:instrumentation* / Q000379:methods; D010147:Pain Measurement; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012584:Sciatic Nerve / Q000000981:diagnostic imaging*; D012677:Sensation / Q000187:drug effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local