TY - JOUR
T1 - Effects of the intraneural and subparaneural ultrasound-guided popliteal sciatic nerve block a prospective, randomized, double-blind clinical and electrophysiological comparison
AU - Cappelleri, Gianluca
AU - Cedrati, Valeria Libera Eva
AU - Fedele, Luisa Luciana
AU - Gemma, Marco
AU - Camici, Laura
AU - Loiero, Mario
AU - Gallazzi, Mauro Battista
AU - Cornaggia, Gabriele
PY - 2016/6/21
Y1 - 2016/6/21
N2 - Background and Objectives: This prospective, randomized, doubleblind study compared the effects of the ultrasound-guided popliteal sciatic nerve block performed by either intraneural or subparaneural approach followed by an electrophysiological evaluation. We hypothesized that intraneural injection provides a faster onset with a better success rate compared with the subparaneural approach. Methods: Eighty-eight patients were enrolled and randomized to receive an ultrasound-guided popliteal sciatic nerve block injecting 15 mL ropivacaine 1% according to an intraneural injection (group INTRA = 44) or a subparaneural injection (group SUBPARA = 44). The primary end point was the onset time of sensory and motor block, whereas secondary end points were successful, duration of the block, and the variation of the electrophysiological assessment after 5 weeks. The study was registered prior to patient enrollment (clinicaltrials.gov identifier NCT01987128). Results: The median onset time for successful sciatic nerve block in the INTRA group was 10 (5-15 [5-30]) minutes versus 25 (15-35 [5-45])minutes in the SUBPARA group (P <0.001), with a rate of 41/43 (95.3%) comparedwith 25/40 (62.5%) in the SUBPARA group (P <0.001).No difference was found regardless of the duration of the block. Fifty-three patients also performed the electrophysiological assessment at 5 weeks, showing a subclinical, significant reduction in amplitude of the action potentials with no difference between groups. No patients reported any clinical neurological complications after 6 months. Conclusions: In ultrasound-guided popliteal sciatic nerve block, intraneural injection provided a faster onset and better success rate compared with subparaneural. Both techniques resulted in a similar subclinical reduction in amplitude of the sciatic action potentials at 5 weeks after surgery. These findings should not be extended to other approaches.
AB - Background and Objectives: This prospective, randomized, doubleblind study compared the effects of the ultrasound-guided popliteal sciatic nerve block performed by either intraneural or subparaneural approach followed by an electrophysiological evaluation. We hypothesized that intraneural injection provides a faster onset with a better success rate compared with the subparaneural approach. Methods: Eighty-eight patients were enrolled and randomized to receive an ultrasound-guided popliteal sciatic nerve block injecting 15 mL ropivacaine 1% according to an intraneural injection (group INTRA = 44) or a subparaneural injection (group SUBPARA = 44). The primary end point was the onset time of sensory and motor block, whereas secondary end points were successful, duration of the block, and the variation of the electrophysiological assessment after 5 weeks. The study was registered prior to patient enrollment (clinicaltrials.gov identifier NCT01987128). Results: The median onset time for successful sciatic nerve block in the INTRA group was 10 (5-15 [5-30]) minutes versus 25 (15-35 [5-45])minutes in the SUBPARA group (P <0.001), with a rate of 41/43 (95.3%) comparedwith 25/40 (62.5%) in the SUBPARA group (P <0.001).No difference was found regardless of the duration of the block. Fifty-three patients also performed the electrophysiological assessment at 5 weeks, showing a subclinical, significant reduction in amplitude of the action potentials with no difference between groups. No patients reported any clinical neurological complications after 6 months. Conclusions: In ultrasound-guided popliteal sciatic nerve block, intraneural injection provided a faster onset and better success rate compared with subparaneural. Both techniques resulted in a similar subclinical reduction in amplitude of the sciatic action potentials at 5 weeks after surgery. These findings should not be extended to other approaches.
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U2 - 10.1097/AAP.0000000000000413
DO - 10.1097/AAP.0000000000000413
M3 - Article
AN - SCOPUS:84976320546
VL - 41
SP - 430
EP - 437
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
SN - 1098-7339
IS - 4
ER -