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Subgluteal Sciatic Nerve Block

Sung Hye Byun, Jonghoon Lee, Jong Hae Kim
BACKGROUND: Patients on antiplatelet therapy following percutaneous coronary intervention can become coagulopathic due to infection. Performing regional anesthesia for bilateral surgery in such cases is challenging. We report a case of successful combined inguinal femoral and subgluteal sciatic nerve blocks (CFSNBs) for simultaneous bilateral below-knee amputations in a coagulopathic patient on antiplatelet therapy. METHODS: A 70-year-old male patient presented with pain in both feet due to diabetic foot syndrome...
July 2016: Medicine (Baltimore)
Hiroto Yamamoto, Shinichi Sakura, Minori Wada, Akemi Shido
BACKGROUND: It is believed that local anesthetic injected to obtain circumferential spread around nerves produces a more rapid onset and successful blockade after some ultrasound-guided peripheral nerve blocks. However, evidence demonstrating this point is limited only to the popliteal sciatic nerve block, which is relatively easy to perform by via a high-frequency linear transducer. In the present study, we tested the hypothesis that multiple injections of local anesthetic to make circumferential spread would improve the rate of sensory and motor blocks compared with a single-injection technique for ultrasound-guided subgluteal sciatic nerve block, which is considered a relatively difficult block conducted with a low-frequency, curved-array transducer...
December 2014: Anesthesia and Analgesia
Tarek F Tammam
PURPOSE: Our aim was compare onset time of sciatic nerve blockade (SNB) performed distal to the subgluteal fold using four different ultrasound (US)-guided approaches in patients undergoing foot or ankle surgery. METHODS: Patients were assigned to one of four groups: SI patients received SNB using short-axis (SA) view of the SN and in-plane (IP) placement of block needle (SA-IP approach); LI patients received SNB using long-axis (LA) view of the SN and IP needle placement (LA-IP approach); SO patients received the block using SA view of the SN and out-of-plane (OP) needle placement (SA-OP approach); LO patients received SNB using LA view of the SN and OP needle placement (LA-OP)...
August 2014: Journal of Anesthesia
Kaoru Hara, Shinichi Sakura, Naomi Yokokawa
PURPOSE: Nerve stimulation may be combined with ultrasound imaging for a block of deeply located nerves such as the sciatic nerve in the subgluteal region. At present, it is unknown how the use of nerve stimulation affects blockade after this nerve block. We retrospectively compared the effects of the two types of motor response and those of minimal evoked current above and below 0.5 mA on ultrasound-guided subgluteal sciatic nerve block using mepivacaine or ropivacaine, two local anesthetics with different onset time and duration...
August 2014: Journal of Anesthesia
Faraj W Abdallah, Vincent W Chan, Arkadiy Koshkin, Sherif Abbas, Richard Brull
BACKGROUND AND OBJECTIVES: Despite ultrasound (US) guidance, sciatic nerve block (SNB) remains among the least performed peripheral blocks. By targeting the tissue plane between the gluteus maximus and quadratus femoris muscles, the US-guided subgluteal space technique may facilitate the performance of US-guided SNB. We aimed to evaluate whether the subgluteal space technique shortens SNB performance time in overweight and obese patients compared with the conventional infragluteal technique...
November 2013: Regional Anesthesia and Pain Medicine
F G A M van Haren, L Kadic, J J Driessen
BACKGROUND: In the present study, we assessed the relationship between subgluteal sciatic nerve blocking and skin temperature by infrared thermography in the lower extremity. We hypothesized that blocking the sciatic nerve will lead to an increase in temperature, and that this will correlate with existing sensory block tests. METHODS: We studied 18 healthy individuals undergoing orthopaedic surgery of the foot under ultrasound-guided subgluteal blockade of the sciatic nerve with 30 ml ropivacaine 7...
October 2013: Acta Anaesthesiologica Scandinavica
P Cuvillon, V Reubrecht, L Zoric, L Lemoine, M Belin, O Ducombs, A Birenbaum, B Riou, O Langeron
BACKGROUND: Although animal studies demonstrated delayed recovery after nerve block in laboratory models of diabetes, the duration of the action of sciatic nerve blocks clinically in patients with diabetes remains to be determined. We studied the duration of a sciatic nerve block in type 2 diabetic patients compared with non-diabetic patients. METHODS: We prospectively included consecutive patients aged 50-80 yr, with type 2 diabetes with minor nerve injury (confirmed with 5...
May 2013: British Journal of Anaesthesia
Kaoru Hara, Shinichi Sakura, Naomi Yokokawa, Saki Tadenuma
BACKGROUND: The present study was conducted to determine the incidence of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block using a low-frequency transducer. We also observed the effects of intraneural injection using ropivacaine and mepivacaine. METHODS: Enrolled in the study were 325 patients undergoing arthroscopic knee surgery, who each received a subgluteal sciatic nerve block under ultrasound guidance using 1.5% mepivacaine with 1:400,000 epinephrine or 0...
May 2012: Regional Anesthesia and Pain Medicine
Andrew D Rosenberg, Jovan Popovic, David B Albert, Robert A Altman, Mitchell H Marshall, Richard M Sommer, Germaine Cuff
Simulation-based training is becoming an accepted tool for educating physicians before direct patient care. As ultrasound-guided regional anesthesia (UGRA) becomes a popular method for performing regional blocks, there is a need for learning the technical skills associated with the technique. Although simulator models do exist for learning UGRA, they either contain food and are therefore perishable or are not anatomically based. We developed 3 sonoanatomically based partial-task simulators for learning UGRA: an upper body torso for learning UGRA interscalene and infraclavicular nerve blocks, a femoral manikin for learning UGRA femoral nerve blocks, and a leg model for learning UGRA sciatic nerve blocks in the subgluteal and popliteal areas...
January 2012: Regional Anesthesia and Pain Medicine
Antoun Nader, Mark C Kendall, Robert Doty, Alexander DeLeon, Edward Yaghmour, Armen S Kelikian, Robert J McCarthy
BACKGROUND: Supplemental peripheral nerve blocks are not commonly performed in adults because of concerns of cumulative exposure of the nerve to the local anesthetic as well as increased ischemia from epinephrine. The purpose of this study was to compare the incidence of postoperative neurologic symptoms after a failed subgluteal sciatic nerve block and a supplemental popliteal sciatic nerve block. METHODS: Five hundred twelve adult patients undergoing ambulatory surgery were prospectively studied (1 yr)...
September 2011: Anesthesiology
Ivo F Panhuizen, Marc M J Snoeck
Ultrasound guidance has made it possible to carry out an anterior approach to sciatic nerve block. This technique can be performed as fast and as successfully as the posterior or subgluteal approach. A major advantage of this technique is that the patient can remain comfortable in a neutral supine position.
2011: Nederlands Tijdschrift Voor Geneeskunde
Nizar Moayeri, Geert J van Geffen, Jörgen Bruhn, Vincent W Chan, Gerbrand J Groen
BACKGROUND AND OBJECTIVES: Efficient identification of the sciatic nerve (SN) requires a thorough knowledge of its topography in relation to the surrounding structures. Anatomic cross sections in similar oblique planes as observed during SN ultrasonography are lacking. A survey of sonoanatomy matched with ultrasound views of the major SN block sites will be helpful in pattern recognition, especially when combined with images that show the internal architecture of the nerve. METHODS: From 1 cadaver, consecutive parts of the upper leg corresponding to the 4 major blocks sites were sectioned and deeply frozen...
September 2010: Regional Anesthesia and Pain Medicine
Vrushali C Ponde, Ankit P Desai, Shalini Dhir
BACKGROUND AND OBJECTIVES: The primary objective of this study was to assess the success rate of ultrasound-guided sciatic needle placement regardless of the motor stimulation in infants and toddlers. METHODS: Forty-five consecutive patients aged 7 months-2 years, scheduled for foot surgery, were included in this prospective, descriptive and blinded study. After induction of general anesthesia, sciatic nerve block was performed under ultrasound guidance in the subgluteal area using an insulated needle connected to a nerve stimulator, with the power off...
July 2010: Paediatric Anaesthesia
Geert-Jan van Geffen, Thierry Pirotte, Mathieu J Gielen, GertJan Scheffer, Jörgen Bruhn
STUDY OBJECTIVE: To present the use of ultrasonography for the performance of proximal subgluteal and distal sciatic nerve blocks in children. DESIGN: Prospective descriptive study. SETTING: University hospital. PATIENTS: 45 ASA physical status I, II, and III patients, aged between 8 months and 16 years, scheduled for lower limb surgery. INTERVENTIONS: During general anesthesia, proximal, subgluteal, and distal sciatic nerve blocks using ultrasonography were performed...
June 2010: Journal of Clinical Anesthesia
Anupama Wadhwa, Heather Tlucek, Daniel Sessler
BACKGROUND: Blockade of the sciatic nerve is necessary for complete analgesia of the lower extremity using peripheral nerve blocks. We identified the sciatic nerve in relation to the ischial tuberosity in fresh cadaver dissections as well as in patients to compare sciatic nerve blockade using the conventional approach versus our experimental approach. Specifically, we tested the hypothesis that in patients in the prone position, our novel approach (changing the point of needle insertion to 3 cm lateral from the ischial tuberosity) requires fewer needle passes and less time...
March 1, 2010: Anesthesia and Analgesia
Giorgio Danelli, Daniela Ghisi, Andrea Fanelli, Andrea Ortu, Elisa Moschini, Marco Berti, Stefanie Ziegler, Guido Fanelli
BACKGROUND: We tested the hypothesis that ultrasound (US) guidance may reduce the minimum effective anesthetic volume (MEAV(50)) of 1.5% mepivacaine required to block the sciatic nerve with a subgluteal approach compared with neurostimulation (NS). METHODS: After premedication and single-injection femoral nerve block, 60 patients undergoing knee arthroscopy were randomly allocated to receive a sciatic nerve block with either NS (n = 30) or US (n = 30). In the US group, the sciatic nerve was localized between the ischial tuberosity and the greater trochanter...
November 2009: Anesthesia and Analgesia
Nizar Moayeri, Gerbrand J Groen
BACKGROUND: In sciatic nerve (SN) blocks, differences are seen in risk of nerve damage, minimum effective anesthetic volume, and onset time. This might be related to differences in the ratio neural:nonneural tissue within the nerve. For the brachial plexus, a higher proximal ratio may explain the higher risk for neural injury in proximal nerve blocks. A similar trend in risk is reported for SN; however, equivalent quantitative data are lacking. The authors aimed to determine the ratio neural:nonneural tissue within SN in situ in the upper leg...
November 2009: Anesthesiology
J Bruhn, N Moayeri, G J Groen, A VAN Veenendaal, M J Gielen, G J Scheffer, G-J VAN Geffen
BACKGROUND AND OBJECTIVES: The sciatic nerve block represents one of the more difficult ultrasound-guided nerve blocks. Easy and reliable internal ultrasound landmarks would be helpful for localization of the sciatic nerve. Earlier, during ultrasound-guided posterior approaches to the infragluteal sciatic nerve, the authors recognized a hyperechoic structure at the medial border of the long head of biceps femoris muscle (BFL). The present study was performed to determine whether this is a potential internal landmark to identify the infragluteal sciatic nerve...
August 2009: Acta Anaesthesiologica Scandinavica
Junichi Ota, Shinichi Sakura, Kaoru Hara, Yoji Saito
BACKGROUND: Although the anterior approach to the sciatic nerve block has rarely been performed due to lack of reliable surface anatomical landmarks and technical difficulty, ultrasound guidance may make performance of this approach easier. In this study, we evaluated the clinical use of the ultrasound-guided anterior approach to sciatic nerve block and compared this approach with the posterior approach in adults. METHODS: One hundred patients undergoing minor knee surgery were randomly divided into two groups to receive anterior and posterior (subgluteal) approaches to sciatic nerve block, using 1...
February 2009: Anesthesia and Analgesia
J Bruhn, G-J Van Geffen, M J Gielen, G J Scheffer
BACKGROUND: The sciatic nerve block by the posterior approaches represents one of the more difficult ultrasound-guided nerve blocks. Our clinical experiences with these blocks indicated a point slightly distal to the subgluteal fold as an advantageous position to allow good ultrasonic visibility. In this study, we systematically scanned the sciatic nerve from the subgluteal fold to the popliteal crease, to determine an optimal point for ultrasonographic visualization. METHODS: After institutional approval and written informed consent, we recruited 15 volunteers to visualize the sciatic nerve from the subgluteal fold to the popliteal crease using a linear ultrasound probe in the range of 7-13 MHz...
October 2008: Acta Anaesthesiologica Scandinavica
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