title: Starting with ultrasonography decreases popliteal block performance time in inexperienced hands: a prospective randomized study.
abstract: BACKGROUND
  The widespread of hallux valgus surgery in a day care setting enhanced the role of regional anaesthesia in the last few years. Sciatic nerve block at popliteal fossa has been shown to provide safe and effective analgesia. Our purpose was to compare the success rate and performance time of popliteal block during resident's training for regional anaesthesia by using nerve stimulation (NS) or combined nerve stimulation and ultrasound (NS + US).
  
  
  METHODS
  70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. Two residents experienced with nerve stimulator performed the procedures after a learning phase concerning ultrasonography. A local anaesthetic solution, containing 10 mL of 0.75% ropivacaine and 10 mL of 2% lidocaine was used: 12 mL were infiltrated close the tibial nerve, and 8mL were infiltrated close the common peroneal nerve. Block success rate, sensory block onset time, block performance time were evaluated. Recourse to general anaesthesia was considered as failure.
  
  
  RESULTS
  No differences were detected in success rate and onset time of sensory block between the two groups (P > 0.05). The time to block tibial nerve and the overall block time were significantly faster in US+NS  group (P < 0.05).
  
  
  CONCLUSIONS
  Ultrasound guidance for popliteal nerve block resulted in similar success rate with a faster procedure time when compared with nerve stimulator, thus providing a possible effect on resident education and operating room efficiency.
authors.affiliation: Foot and Ankle Unit, Galeazzi Hospital, via Riccardo Galeazzi 4, 20161, Milan, Italy. n.martinelli@unicampus.it.
authors.forename: Rita
authors.initials: R
authors.lastname: Cataldo
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Carassiti
authors.forename: Fabio
authors.initials: F
authors.lastname: Costa
authors.forename: Matteo
authors.initials: M
authors.lastname: Martuscelli
authors.forename: Maria
authors.initials: M
authors.lastname: Benedetto
authors.forename: Francesco
authors.initials: F
authors.lastname: Cancilleri
authors.forename: Andrea
authors.initials: A
authors.lastname: Marinozzi
authors.forename: Nicolò
authors.initials: N
authors.lastname: Martinelli