A randomized comparison of long-axis and short-axis imaging for in-plane ultrasound-guided popliteal-sciatic perineural catheter insertion

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• 作者：T. Edward Kim (1) (3)
  Steven K. Howard (1) (3)
  Natasha Funck (1) (3)
  T. Kyle Harrison (1) (3)
  Tessa L. Walters (1) (3)
  Michael J. Wagner (1) (3)
  Toni Ganaway (1) (3)
  Jonah Mullens (2)
  Bruce Lehnert (2)
  Edward R. Mariano (1) (3)
  
• 关键词：Continuous peripheral nerve block ; Perineural catheter ; Ultrasound ; guided regional anesthesia ; Sciatic nerve block ; Foot and ankle surgery
• 刊名：Journal of Anesthesia
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：28
• 期：6
• 页码：854-860
• 全文大小：341 KB
• 参考文献：1. Singelyn FJ, Aye F, Gouverneur JM. Continuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery. Anesth Analg. 1997;84:383-.
  2. Ilfeld BM, Morey TE, Wang RD, Enneking FK. Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology. 2002;97:959-5. CrossRef
  3. White PF, Issioui T, Skrivanek GD, Early JS, Wakefield C. The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003;97:1303-. CrossRef
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  5. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259-5. CrossRef
  6. Ilfeld BM, Fredrickson MJ, Mariano ER. Ultrasound-guided perineural catheter insertion: three approaches but few illuminating data. Reg Anesth Pain Med. 2010;35:123-. CrossRef
  7. Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Lee DK, Maldonado RC, Ilfeld BM. Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med. 2009;34:480-. CrossRef
  8. Mariano ER, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Afra R, Ball ST, Meyer RS, Maldonado RC, Ilfeld BM. Ultrasound guidance versus electrical stimulation for femoral perineural catheter insertion. J Ultrasound Med. 2009;28:1453-0.
  9. Mariano ER, Loland VJ, Sandhu NS, Bishop ML, Lee DK, Schwartz AK, Girard PJ, Ferguson EJ, Ilfeld BM. Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia. Can J Anaesth. 2010;57:919-6. CrossRef
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  13. Mariano ER, Kim TE, Funck N, Walters T, Wagner MJ, Harrison TK, Giori N, Woolson S, Ganaway T, Howard SK. A randomized comparison of long-and short-axis imaging for in-plane ultrasound-guided femoral perineural catheter insertion. J Ultrasound Med. 2013;32:149-6.
  14. Sahin L, Gurkan Y. “Figure of four-position and long-axis sciatic nerve scan with ultrasound facilitates sciatic perineural catheter placement. Agri. 2010;22:175-.
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• 作者单位：T. Edward Kim (1) (3)
  Steven K. Howard (1) (3)
  Natasha Funck (1) (3)
  T. Kyle Harrison (1) (3)
  Tessa L. Walters (1) (3)
  Michael J. Wagner (1) (3)
  Toni Ganaway (1) (3)
  Jonah Mullens (2)
  Bruce Lehnert (2)
  Edward R. Mariano (1) (3)
  
  1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
  3. Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (112A), Palo Alto, 94304, CA, USA
  2. Podiatry Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
  
• ISSN：1438-8359

文摘

Purpose Ultrasound-guided long-axis in-plane sciatic perineural catheter insertion has been described but not validated. For the popliteal-sciatic nerve, we hypothesized that a long-axis in-plane technique, placing the catheter parallel and posterior to the nerve, results in faster onset of sensory anesthesia compared to a short-axis in-plane technique. Methods Preoperatively, patients receiving a popliteal-sciatic perineural catheter were randomly assigned to either the long-axis or short-axis technique. Mepivacaine 2?% was administered via the catheter following insertion. The primary outcome was time to achieve complete sensory anesthesia. Secondary outcomes included procedural time, onset time of motor block, and pain on postoperative day?1. Results Fifty patients were enrolled. In the long-axis group (n?=?25), all patients except 1 (4?%) had successful catheter placement per protocol. Two patients (8?%) in the long-axis group and 1 patient (4?%) in the short-axis group (n?=?25) did not achieve sensory anesthesia by 30?min and were withdrawn. Seventeen of 24 (71?%) and 17 of 22 (77?%) patients in the short-axis and long-axis groups, respectively, achieved the primary outcome of complete sensory anesthesia (p?=?0.589). The short-axis group (n?=?17) required a median (10th-0th?- of 18.0 (8.4-0.0)?min compared to 18.0 (11.4-7.6)?min for the long-axis group (n?=?17, p?=?0.208) to achieve complete sensory anesthesia. Procedural time was 6.5 (4.0-2.0)?min for the short-axis and 9.5 (7.0-2.7)?min for the long-axis (p? Conclusion Long-axis in-plane popliteal-sciatic perineural catheter insertion requires more time to perform compared to a short-axis in-plane technique without demonstrating any advantages.