Ultrasound-Guided Popliteal Sciatic Nerve Block
The objective of this research was to improve techniques to block sciatic nerve and its branches in the popliteal fossa by comparing two methods of ultrasound imaging: in-plane and out-of-plane. Material and Methods of the Research. The study included 35 patients divided into 2 groups: in group 1 patients (n = 19), ultrasound monitoring of the needle enter was carried out with in-plane approach, in group 2 — with out-of-plane (n = 16). The effectiveness of the block was evaluated in 30 minutes: a block considered good (3 points) if surgery was performed without additional sedation, satisfactory (2 points) if required intravenous sedation, and unsatisfactory (1 point) if required intravenous anesthesia. Pain during nerve block was assessed by visual analogue scale. The duration of motor block in hours was evaluated too. Results. In group 1 patients, pain during blockade was estimated as 4.9 ± 1.3 points by visual analogue scale, in group 2 patients — 3.6 ± 1.5 points, p = 0.01. The effectiveness of anesthesia in patients from groups 1 and 2 was almost identical. Duration of anesthesia in patients of group 1 was 5.7 ± 1.0 hours, in group 2 — 5.9 ± 1.0 hours (p < 0.05). Conclusions. In good ultrasonic imaging of the sciatic nerve and its bifurcation, introduction of 25 ml of local anesthetic in the fissure between n.tibialis n.peroneus communis using out-of-plane approach is as effective to perform block, as in-plane approach, but is less painful for a patient.
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