Nerve Block

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Robert S Weller - One of the best experts on this subject based on the ideXlab platform.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND: Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS: Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS: The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P CONCLUSIONS: Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P < 0.001). A lower volume of ropivacaine 0.5% was used for the tibial Nerve Block, 8.7 mL (99% CI, 7.9 to 9.4) versus 15.2 mL (99% CI, 14.9 to 15.5), respectively (99% CI for difference between means, 5.6 to 7.3; P < 0.001). No patient receiving a tibial Nerve Block developed complete peroneal motor Block compared to 82.5% of patients with sciatic Nerve Block (P < 0.001). There were no significant differences in the pain scores and opioid consumption between the groups. CONCLUSIONS Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • ultrasound guided obturator Nerve Block an interfascial injection approach without Nerve stimulation
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Timothy T Houle, Robert S Weller
    Abstract:

    Background and Objectives: For knee surgery, obturator Nerve Block (ONB) has been shown to enhance postoperative analgesia provided by femoral Block. Current techniques for obturator Block use surface landmarks or ultrasound guidance (USG) with Nerve stimulation. This preliminary observational study evaluated the success of an ultrasound-guided ONB without the additional use of Nerve stimulation. Methods: Thirty patients scheduled for knee surgery under general anesthesia with Nerve Block for postoperative analgesia had ONB performed using USG and injection of 10 mL 0.5% ropivacaine with epinephrine. Half of the ropivacaine was injected between the pectineus and adductor brevis muscles, and half between the adductor brevis and adductor magnus muscles. The strength of thigh adduction was measured at 5, 10, and 15 mins after injection, and 50% strength reduction at 15 mins indicated a successful Block. Results: All patients showed reduction of strength, and 28 of 30 or 93% met the criteria for successful Block with mean strength reduction of 82.2% (SD, 21.6%) at 15 mins. Blocks were completed in 122 secs (SD, 33 secs). Conclusions: Obturator Nerve Block using USG to achieve interfascial injection without Nerve stimulation had success similar to that reported in studies using Nerve stimulation.

Sanjay K Sinha - One of the best experts on this subject based on the ideXlab platform.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND: Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS: Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS: The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P CONCLUSIONS: Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P < 0.001). A lower volume of ropivacaine 0.5% was used for the tibial Nerve Block, 8.7 mL (99% CI, 7.9 to 9.4) versus 15.2 mL (99% CI, 14.9 to 15.5), respectively (99% CI for difference between means, 5.6 to 7.3; P < 0.001). No patient receiving a tibial Nerve Block developed complete peroneal motor Block compared to 82.5% of patients with sciatic Nerve Block (P < 0.001). There were no significant differences in the pain scores and opioid consumption between the groups. CONCLUSIONS Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • ultrasound guided obturator Nerve Block an interfascial injection approach without Nerve stimulation
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Timothy T Houle, Robert S Weller
    Abstract:

    Background and Objectives: For knee surgery, obturator Nerve Block (ONB) has been shown to enhance postoperative analgesia provided by femoral Block. Current techniques for obturator Block use surface landmarks or ultrasound guidance (USG) with Nerve stimulation. This preliminary observational study evaluated the success of an ultrasound-guided ONB without the additional use of Nerve stimulation. Methods: Thirty patients scheduled for knee surgery under general anesthesia with Nerve Block for postoperative analgesia had ONB performed using USG and injection of 10 mL 0.5% ropivacaine with epinephrine. Half of the ropivacaine was injected between the pectineus and adductor brevis muscles, and half between the adductor brevis and adductor magnus muscles. The strength of thigh adduction was measured at 5, 10, and 15 mins after injection, and 50% strength reduction at 15 mins indicated a successful Block. Results: All patients showed reduction of strength, and 28 of 30 or 93% met the criteria for successful Block with mean strength reduction of 82.2% (SD, 21.6%) at 15 mins. Blocks were completed in 122 secs (SD, 33 secs). Conclusions: Obturator Nerve Block using USG to achieve interfascial injection without Nerve stimulation had success similar to that reported in studies using Nerve stimulation.

Eric Albrecht - One of the best experts on this subject based on the ideXlab platform.

Markus F Stevens - One of the best experts on this subject based on the ideXlab platform.

  • value of single injection or continuous sciatic Nerve Block in addition to a continuous femoral Nerve Block in patients undergoing total knee arthroplasty a prospective randomized controlled trial
    Regional Anesthesia and Pain Medicine, 2011
    Co-Authors: Jessica T Wegener, Markus W Hollmann, Bas Van Ooij, Niek C Van Dijk, Benedikt Preckel, Markus F Stevens
    Abstract:

    Continuous femoral Nerve Block in patients undergoing total knee arthroplasty (TKA) improves and shortens postoperative rehabilitation. The primary aim of this study was to investigate whether the addition of sciatic Nerve Block to continuous femoral Nerve Block will shorten the time-to-discharge readiness. Ninety patients undergoing TKA were prospectively randomized to 1 of 3 groups: patient-controlled analgesia via femoral Nerve catheter alone (F group) or combined with a single-injection (Fs group) or continuous sciatic Nerve Block (FCS group) until the second postoperative day. Discharge readiness was defined as the ability to walk and climb stairs independently, average pain on a numerical rating scale at rest lower than 4, and no complications. In addition, knee function, pain, supplemental morphine requirement, local anesthetic consumption, and postoperative nausea and vomiting (PONV) were evaluated. Median time-to-discharge readiness was similar: F group, 4 days (range, 2-16 days); Fs group, 4 days (range, 2-7 days); and FCS group, 4 days (range, 2-9 days; P = 0.631). No significant differences were found regarding knee function, local anesthetic consumption, or postoperative nausea and vomiting. During the day of surgery, pain was moderate to severe in the F group, whereas Fs and FCS groups experienced minimal pain (P < 0.01). Patients in the F group required significantly more supplemental morphine on the day of surgery and the first postoperative day. Until the second postoperative day, pain was significantly less in the FCS group (P < 0.01). A single-injection or continuous sciatic Nerve Block in addition to a femoral Nerve Block did not influence time-to-discharge readiness. A single-injection sciatic Nerve Block can reduce severe pain on the day of the surgery, whereas a continuous sciatic Nerve Block reduces moderate pain during mobilization on the first 2 postoperative days

  • value of single injection or continuous sciatic Nerve Block in addition to a continuous femoral Nerve Block in patients undergoing total knee arthroplasty a prospective randomized controlled trial
    Regional Anesthesia and Pain Medicine, 2011
    Co-Authors: Jessica T Wegener, Markus W Hollmann, Benedikt Preckel, Bas Van Ooij, Niek C Van Dijk, Markus F Stevens
    Abstract:

    Background and Objectives: Continuous femoral Nerve Block in patients undergoing total knee arthroplasty (TKA) improves and shortens postoperative rehabilitation. The primary aim of this study was to investigate whether the addition of sciatic Nerve Block to continuous femoral Nerve Block will shorten the time-to-discharge readiness. Methods: Ninety patients undergoing TKA were prospectively randomized to 1 of 3 groups: patient-controlled analgesia via femoral Nerve catheter alone (F group) or combined with a single-injection (Fs group) or continuous sciatic Nerve Block (FCS group) until the second postoperative day. Discharge readiness was defined as the ability to walk and climb stairs independently, average pain on a numerical rating scale at rest lower than 4, and no complications. In addition, knee function, pain, supplemental morphine requirement, local anesthetic consumption, and postoperative nausea and vomiting (PONV) were evaluated. Results: Median time-to-discharge readiness was similar: F group, 4 days (range, 2-16 days); Fs group, 4 days (range, 2-7 days); and FCS group, 4 days (range, 2-9 days; P = 0.631). No significant differences were found regarding knee function, local anesthetic consumption, or postoperative nausea and vomiting. During the day of surgery, pain was moderate to severe in the F group, whereas Fs and FCS groups experienced minimal pain (P Conclusions: A single-injection or continuous sciatic Nerve Block in addition to a femoral Nerve Block did not influence time-to-discharge readiness. A single-injection sciatic Nerve Block can reduce severe pain on the day of the surgery, whereas a continuous sciatic Nerve Block reduces moderate pain during mobilization on the first 2 postoperative days.

Jonathan H Abrams - One of the best experts on this subject based on the ideXlab platform.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND: Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS: Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS: The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P CONCLUSIONS: Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • femoral Nerve Block with selective tibial Nerve Block provides effective analgesia without foot drop after total knee arthroplasty a prospective randomized observer blinded study
    Anesthesia & Analgesia, 2012
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Sivasenthil Arumugam, John G Dalessio, David G Freitas, John T Barnett, Robert S Weller
    Abstract:

    BACKGROUND Sciatic Nerve Block when combined with femoral Nerve Block for total knee arthroplasty may provide superior analgesia but can produce footdrop, which may mask surgically induced peroneal Nerve injury. In this prospective, randomized, observer-blinded study, we evaluated whether performing a selective tibial Nerve Block in the popliteal fossa would avoid complete peroneal motor Block. METHODS Eighty patients scheduled for primary total knee arthroplasty were randomized to receive either a tibial Nerve Block in the popliteal fossa or a sciatic Nerve Block proximal to its bifurcation in combination with femoral Nerve Block as part of a multimodal analgesia regimen. Local anesthetic solution of sufficient volume to encircle the target Nerve was administered for the Block, up to a maximum of 20 mL. General anesthesia was administered for surgery. After emergence from anesthesia, in the recovery room, the presence or absence of peroneal sensory and motor Block was noted. Pain scores and opioid consumption were recorded for 24 hours after surgery. RESULTS The tibial Nerve Block and sciatic Nerve Block were performed 1.7 cm (99% CI, 1.3 to 2.1) and 9.4 cm (99% CI, 8.3 to 10.5) proximal to the popliteal crease, respectively (99% CI for difference between means: 6.4 to 9.0; P < 0.001). A lower volume of ropivacaine 0.5% was used for the tibial Nerve Block, 8.7 mL (99% CI, 7.9 to 9.4) versus 15.2 mL (99% CI, 14.9 to 15.5), respectively (99% CI for difference between means, 5.6 to 7.3; P < 0.001). No patient receiving a tibial Nerve Block developed complete peroneal motor Block compared to 82.5% of patients with sciatic Nerve Block (P < 0.001). There were no significant differences in the pain scores and opioid consumption between the groups. CONCLUSIONS Tibial Nerve Block performed in the popliteal fossa in close proximity to the popliteal crease avoided complete peroneal motor Block and provided similar postoperative analgesia compared to sciatic Nerve Block when combined with femoral Nerve Block for patients undergoing total knee arthroplasty.

  • ultrasound guided obturator Nerve Block an interfascial injection approach without Nerve stimulation
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Sanjay K Sinha, Jonathan H Abrams, Timothy T Houle, Robert S Weller
    Abstract:

    Background and Objectives: For knee surgery, obturator Nerve Block (ONB) has been shown to enhance postoperative analgesia provided by femoral Block. Current techniques for obturator Block use surface landmarks or ultrasound guidance (USG) with Nerve stimulation. This preliminary observational study evaluated the success of an ultrasound-guided ONB without the additional use of Nerve stimulation. Methods: Thirty patients scheduled for knee surgery under general anesthesia with Nerve Block for postoperative analgesia had ONB performed using USG and injection of 10 mL 0.5% ropivacaine with epinephrine. Half of the ropivacaine was injected between the pectineus and adductor brevis muscles, and half between the adductor brevis and adductor magnus muscles. The strength of thigh adduction was measured at 5, 10, and 15 mins after injection, and 50% strength reduction at 15 mins indicated a successful Block. Results: All patients showed reduction of strength, and 28 of 30 or 93% met the criteria for successful Block with mean strength reduction of 82.2% (SD, 21.6%) at 15 mins. Blocks were completed in 122 secs (SD, 33 secs). Conclusions: Obturator Nerve Block using USG to achieve interfascial injection without Nerve stimulation had success similar to that reported in studies using Nerve stimulation.