title: Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery.
abstract: OBJECTIVE
  To determine whether ultrasound guidance improves the quality of continuous popliteal block when compared with a nerve stimulator after major foot and ankle surgery.
  
  
  METHODS
  Prospective, randomized, double-blinded clinical trial.
  
  
  METHODS
  Operating room, Postanesthesia Care Unit (PACU), and hospital wards of a university-affiliated hospital.
  
  
  METHODS
  45 ASA physical status 1, 2, and 3 patients undergoing elective major foot and ankle surgery.
  
  
  METHODS
  Placement of a popliteal sciactic nerve catheter using either nerve stimulator or ultrasound guidance. In the PACU, a continuous infusion of ropivacaine 0.2% was started at a basal rate of 4 mL/hr and adjusted in a standardized fashion to maintain visual analog scale (VAS) pain scores < 4. All patients also received intravenous (IV) patient-controlled analgesia with hydromorphone and oral opioids.
  
  
  METHODS
  VAS pain scores at rest and with physical therapy, ropivacaine use, opioid use, and opioid-related side effects were recorded.
  
  
  RESULTS
  Cummulative ropivacaine use was lower in patients whose catheter was placed by ultrasound than by nerve stimulator guidance (mean 50 vs 197 mL, P < 0.001). Pain scores at rest and during activity were similar between groups. Cumulative opioid consumption (mean 858 vs 809 mg oral morphine equivalents) and daily frequencies of nausea (5% to 33% vs 0 to 24%) and pruritus (0 to 21% vs 0 to 24%) were similar between groups. Length of hospital stay was similar between groups (3.5 vs 3.7 days).
  
  
  CONCLUSIONS
  Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Maalouf
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Liu
authors.forename: Rana
authors.initials: R
authors.lastname: Movahedi
authors.forename: Enrique
authors.initials: E
authors.lastname: Goytizolo
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memstoudis
authors.forename: Jacques T
authors.initials: JT
authors.lastname: Yadeau
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gordon
authors.forename: Michael
authors.initials: M
authors.lastname: Urban
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Barbara
authors.initials: B
authors.lastname: Wukovits
authors.forename: Dorothy
authors.initials: D
authors.lastname: Marcello
authors.forename: Shane
authors.initials: S
authors.lastname: Reid
authors.forename: Amanda
authors.initials: A
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000842:Ankle / Q000601:surgery; D002404:Catheterization / Q000379:methods; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D005528:Foot / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D011446:Prospective Studies; D000077212:Ropivacaine; D012584:Sciatic Nerve; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004091:Hydromorphone