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dc.contributor.authorWorakamol Tiyaprasertkulen_US
dc.contributor.authorFrancisca Bernuccien_US
dc.contributor.authorAndrea P. Gonzálezen_US
dc.contributor.authorPrangmalee Leurcharusmeeen_US
dc.contributor.authorMurray S. Yazeren_US
dc.contributor.authorWallaya Techasuken_US
dc.contributor.authorVanlapa Arnuntasupakulen_US
dc.contributor.authorDaniel Chora De La Garzaen_US
dc.contributor.authorRoderick J. Finlaysonen_US
dc.contributor.authorQ. H. De Tranen_US
dc.description.abstractCopyright © 2015 by American Society of Regional Anesthesia and Pain Medicine. Background and Objectives This prospective randomized trial compared ultrasound-guided single-injection (SI) and triple-injection (TI) subparaneural popliteal sciatic nerve block. We hypothesized that multiple injections are not required when local anesthetic (LA) is deposited under the paraneurium because the latter entraps LA molecules, ensuring circumferential spread around the nerve. Therefore, in addition to comparable success rates, we also expected similar total anesthesia-related times (sum of performance and onset times) and designed this study as an equivalency trial. Methods Ultrasound-guided subparaneural posterior popliteal sciatic nerve block was carried out in 100 patients. In the SI group, LA was deposited at a single location between the tibial and peroneal nerves. In the TI group, LA was injected between the tibial and peroneal divisions, medial to the tibial nerve, and lateral to the common peroneal nerve. The total LA volume (15 mL) and mixture (lidocaine 1%-bupivacaine 0.25%-epinephrine 5 μg/mL) were identical in all subjects. The performance time, number of needle passes, and adverse events (paresthesia, neural edema) were recorded by the (nonblinded) investigator supervising the block. A blinded observer evaluated the success rate (sensorimotor composite score ≥6/8 points at 30 minutes) as well as the onset time and contacted patients 7 days after the surgery to inquire about persistent numbness or motor deficit. Results Both techniques provided comparable success rates (92%) and total anesthesia-related times (17.1-19.7 minutes). Expectedly, the SI group required fewer needle passes (1 vs 3; P < 0.001) and a shorter needling time (3.0 ± 2.3 minutes vs 4.0 ± 2.3 minutes; P = 0.025). The TI group displayed a shorter onset time (12.5 ± 7.9 minutes vs 15.8 ± 7.9 minutes; P = 0.027). The performance time, procedural discomfort, and incidence of paresthesia (14%-20%) were similar between the 2 groups. Sonographic neural swelling was detected in 2 subjects in the SI group. In both cases, the needle was carefully withdrawn and the injection was completed uneventfully. Follow-up of the 100 subjects 1 week after surgery revealed no residual numbness or motor deficit. Conclusions Ultrasound-guided SI and TI subparaneural popliteal sciatic nerve blocks result in comparable success rates and total anesthesia-related times. Expectedly, the SI technique requires fewer needle passes.en_US
dc.titleA Randomized Comparison between Single- and Triple-Injection Subparaneural Popliteal Sciatic Nerve Blocken_US
article.title.sourcetitleRegional Anesthesia and Pain Medicineen_US
article.volume40en_US Mai Universityen_US de Carabinerosen_US University Health Centre, Montreal General Hospitalen_US
Appears in Collections:CMUL: Journal Articles

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