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Anesth Analg. 2019 Jun;128(6):e104-e108. doi: 10.1213/ANE.0000000000003693.

Continuous Popliteal-Sciatic Blocks for Postoperative Analgesia: Traditional Proximal Catheter Insertion Superficial to the Paraneural Sheath Versus a New Distal Insertion Site Deep to the Paraneural Sheath.

Author information

1
From the Department of Anesthesiology, University of California, San Diego, California.
2
OUTCOMES RESEARCH Consortium, Cleveland, Ohio.
3
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
4
Department of Anesthesiology, Stanford University, Stanford, California.
5
Department of Orthopedics, University of California, San Diego, California.
6
Department of Neurology, University of Southern California, Los Angeles, California.
7
School of Medicine, University of California, San Diego, San Diego, California.

Abstract

We tested the hypothesis that during a continuous popliteal-sciatic nerve block, postoperative analgesia is improved with the catheter insertion point "deep" to the paraneural sheath immediately distal to the bifurcation between the tibial and common peroneal branches, compared with the traditional approach "superficial" to the paraneural sheath proximal to the bifurcation. The needle tip location was determined to be accurately located with a fluid bolus visualized with ultrasound; however, catheters were subsequently inserted without a similar fluid injection and visualization protocol (visualized air injection was permitted and usually implemented, but not required per protocol). The average pain (0-10 scale) the morning after surgery for subjects with a catheter inserted at the proximal subparaneural location (n = 31) was a median (interquartile) of 1.5 (0.0-3.5) vs 1.5 (0.0-4.0) for subjects with a catheter inserted at the distal supraparaneural location (n = 32; P = .927). Secondary outcomes were similarly negative.

PMID:
31094804
DOI:
10.1213/ANE.0000000000003693
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