Distal tourniquet or leg position after injection enhances the efficacy of sciatic nerve blockade by the popliteal approach.

Abstract:

BACKGROUND:In this study, we hypothesized that leg positioning and distal tourniquet application, when compared with neutral positioning of the leg, alters the efficacy of sciatic nerve block performed by the double-stimulation technique. METHODS:Ninety randomized, consecutive, ASA physical status I to III patients undergoing foot and ankle surgery with a popliteal fossa block (using a double-stimulation technique with the patient in prone position) were prospectively studied. Patients were randomized to have the blocked leg either kept in a neutral position immediately after the patient was turned supine (group 1), flexed 45 degrees at the thigh and maintained in that position for 15 minutes (group 2), or have a distal tourniquet applied with the leg in a neutral position and inflated during injection of the local anesthetic with the patient supine (group 3). A standardized local anesthetic mixture containing 15 mL of 2% prilocaine and 15 mL of 0.5% levobupivacaine was used in all study groups. RESULTS:The onset times for sensory and motor blocks were shorter, and the time to recovery of blocks was longer, postprocedure in both group 2 and 3. CONCLUSIONS:Similar beneficial effects might be reached with the application of a distal tourniquet during injection or elevating the patient's leg turned supine immediately after sciatic nerve block with a popliteal approach by a double-injection technique. We suggest that using the leg-up position or application of a distal tourniquet for sciatic nerve block may lead to a more proximal distribution of the local anesthetic and may result in a faster onset of sensory and motor blocks as well as longer duration of blockade.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Sertoz N,Deniz MN,Ayanoglu HO

doi

10.1213/ANE.0b013e31822f8b99

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

1516-20

issue

6

eissn

0003-2999

issn

1526-7598

pii

ANE.0b013e31822f8b99

journal_volume

113

pub_type

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