title: 3D ultrasound estimation of the effective volume for popliteal block at the level of division.
abstract: Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5cm segment.
  
  
  METHODS
  We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of división of the sciatic nerve. Thirty ml of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5cm segment.
  
  
  RESULTS
  All blocks were successful within 20min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8±2.6cm3. Of this, the volume of the halo sorrounding the nerve was 4.4±1.7cm3and the volume inside the sciatic nerve was 2.4±1.7cm3.
  
  
  CONCLUSIONS
  The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7ml.
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España. Electronic address: xsala@clinic.ub.es.
authors: X
authors: X
authors: Sala-Blanch
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España.
authors: J
authors: J
authors: Franco
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España.
authors: R
authors: R
authors: Bergé
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España.
authors: R
authors: R
authors: Marín
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España.
authors: A M
authors: AM
authors: López
authors: Departamento de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España.
authors: M
authors: M
authors: Agustí
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics; D000071378:Bunion / Q000601:surgery; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D004058:Diffusion; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007717:Knee; D000077554:Levobupivacaine; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000493:pharmacokinetics; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D012584:Sciatic Nerve / Q000000981:diagnostic imaging* / Q000187:drug effects; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D008619:Mepivacaine; D002045:Bupivacaine
keywords: Anestesia regional; Anestésico local; Bloqueo poplíteo; Ecoguiado; Local anesthetics; Popliteal block; Regional anesthesia; Ultrasound guided; Volume; Volumen