The Experts below are selected from a list of 2355 Experts worldwide ranked by ideXlab platform
Richard Brull - One of the best experts on this subject based on the ideXlab platform.
-
is Sciatic Nerve Block advantageous when combined with femoral Nerve Block for postoperative analgesia following total knee arthroplasty a meta analysis
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2016Co-Authors: Faraj W Abdallah, Caveh Madjdpour, Richard BrullAbstract:Background Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain despite the use of femoral Nerve Block (FNB). The analgesic benefits of adding Sciatic Nerve Block (SNB) to FNB following TKA are unclear. The aim of this meta-analysis was to quantify the analgesic effects of adding SNB to FNB following TKA.
-
the analgesic effects of proximal distal or no Sciatic Nerve Block on posterior knee pain after total knee arthroplasty a double blind placebo controlled randomized trial
Anesthesiology, 2014Co-Authors: Faraj W Abdallah, Arkadiy Koshkin, Vincent W S Chan, S Abbas, Rajiv Gandhi, Richard BrullAbstract:BACKGROUND The analgesic efficacy of Sciatic Nerve Block (SNB) after total knee arthroplasty (TKA) is unclear. Proximal and distal SNB are each reported to provide posterior knee analgesia, whereas others suggest that posterior knee pain is not important after TKA. This prospective, randomized, double-blind, parallel-arm, placebo-controlled trial examined whether proximal or distal SNB provides superior analgesia in the posterior knee compared with no SNB after TKA. METHODS Sixty patients undergoing TKA were randomized to single-shot SNB using either the infragluteal (Proximal group) or popliteal (Distal group) technique, or no SNB (Placebo group). All patients received spinal anesthesia and continuous-femoral Nerve Blockade. A blinded observer assessed posterior and anterior knee pain at 2, 4, 6, 8, 12, and 24 h postoperatively. The primary outcome was moderate-to-severe posterior knee pain at 4 h postoperatively; secondary outcomes included SNB procedural time, needle passes, and discomfort. RESULTS Fifty-three patients were analyzed. The proportion of patients (Proximal:Distal:Placebo) who experienced moderate-to-severe posterior knee pain was 18%:22%:89% (P<0.00001) at 2 h, 24%:28%:72% (P<0.01) at 4 h, and 12%:17%:78% (P=0.00003) at 6 h postoperatively. For the anterior knee, the proportion of patients reporting moderate-to-severe pain was 6%:11%:44% (P=0.02) at 2 h, 6%:6%:39% (P=0.012) at 4 h, and 12%:6%:44% (P=0.017) at 6 h postoperatively. Moderate-to-severe pain did not differ between groups beyond 6 h. Both proximal and distal SNB reduced rest pain in the posterior and anterior knee up to 8 h postoperatively compared with no SNB. The popliteal technique required shorter procedural time, fewer needle passes, and produced less discomfort. CONCLUSION Proximal and distal SNB each reduce posterior and anterior knee pain after TKA compared with no SNB.
-
is Sciatic Nerve Block advantageous when combined with femoral Nerve Block for postoperative analgesia following total knee arthroplasty a systematic review
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Faraj W Abdallah, Richard BrullAbstract:Sciatic Nerve Block (SNB) is commonly performed in combination with femoral Nerve Block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). This systematic review examines the effects of adding SNB to FNB for TKA compared with FNB alone on acute pain and related outcomes. Four intermediate-quality randomized and 3 observational trials, including a total of 391 patients, were identified. Three of 4 trials investigating the addition of single-shot SNB and 2 of 3 trials investigating continuous SNB reported improved early analgesia at rest and reduced early opioid consumption. Only 2 trials specifically assessed posterior knee pain. We were unable to uncover any clinically important analgesic advantages for SNB beyond 24 hours postoperatively. At present, there is inconclusive evidence in the literature to define the effect of adding SNB to FNB on acute pain and related outcomes compared with FNB alone for TKA.
-
is circumferential injection advantageous for ultrasound guided popliteal Sciatic Nerve Block a proof of concept study
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Richard Brull, Alan Macfarlane, Arkadiy Koshkin, Simon J Parrington, Vincent W S ChanAbstract:Background: Ultrasound (US) guidance, in some instances, can increase the success rate and reduce the onset and procedure times for peripheral Nerve Blockade compared with traditional Nerve localization techniques. The presumptive mechanism for these benefits is the ability to accurately inject local anesthetic circumferentially around the target Nerve. We aimed to determine whether ensuring circumferential spread of local anesthetic is advantageous for US-guided popliteal Sciatic Nerve Block. Methods: Sixty-four adult patients undergoing US-guided popliteal Sciatic Block for elective foot and ankle surgery were randomly assigned to 1 of 2 groups, circumferential or single-location injection. Using a short-axis Nerve view and out-of-plane needle approach, the needle tip was advanced to the posterior external surface of the Sciatic Nerve. A 30-mL local anesthetic admixture (1:1 lidocaine 2%/bupivacaine 0.5% with 1:200,000 epinephrine) was injected either entirely at this location (single location) or incrementally at multiple locations to ensure circumferential spread around the Sciatic Nerve (circumferential). Sensory and motor functions were assessed by a blinded observer at predetermined intervals. The primary outcome was sensory Block defined as loss of sensation to pinprick in the distribution of both tibial and common peroneal Nerves at 30 mins after injection. Results: Sensory Block was achieved in 94% of patients in the circumferential injection group compared with 69% in the single-location injection group (P = 0.010). There were no differences detected in Block performance time, pain during Block performance, or Block-related complications between groups. Conclusions Ultrasound-guided circumferential injection of local anesthetic around the Sciatic Nerve at the popliteal fossa can improve the rate of sensory Block without an increase in Block procedure time or Block-related complications compared with a single-location injection technique.
-
ultrasound guidance improves the success of Sciatic Nerve Block at the popliteal fossa
Regional Anesthesia and Pain Medicine, 2008Co-Authors: Richard Brull, Vincent W S Chan, Anahi Perlas, Colin J L Mccartney, Alina Nuica, S AbbasAbstract:Background and Objectives Real time ultrasound guidance is a recent development in the area of peripheral Nerve Blockade. There are limited data from prospective randomized trials comparing its efficacy to that of traditional Nerve localization techniques. In the present study, we tested the hypothesis that ultrasound guidance improves the success rate of Sciatic Nerve Block at the popliteal fossa when compared with a Nerve stimulator-guided technique. Methods After Institutional Research Ethics Board approval and informed consent, 74 patients undergoing elective major foot or ankle surgery were randomly assigned to receive a Sciatic Nerve Block at the popliteal fossa guided by either ultrasonography (group US, transverse view, needle in plane approach above the Sciatic Nerve bifurcation), or Nerve stimulation (group NS, single injection, 10 cm proximal to the knee crease). A standardized local anesthetic admixture (15 mL of 2% lidocaine with 1:200,000 epinephrine and 15 mL of 0.5% bupivacaine) was used. Sensory and motor function was assessed by a blinded observer at predetermined intervals for up to 1 hour. Block success was defined as a loss of sensation to pinprick within 30 minutes in the distribution of both tibial and common peroneal Nerves. Results Group US had a significantly higher Block success rate than group NS (89.2% vs. 60.6%, P = .005), while the procedure time was similar. Conclusions Ultrasound guidance enhances the quality of popliteal Sciatic Nerve Block compared with single injection, Nerve stimulator-guided Block using either a tibial or peroneal endpoint. Ultrasound guidance resulted in higher success, faster onset, and progression of sensorimotor Block, without an increase in Block procedure time, or complications.
Vincent W S Chan - One of the best experts on this subject based on the ideXlab platform.
-
the analgesic effects of proximal distal or no Sciatic Nerve Block on posterior knee pain after total knee arthroplasty a double blind placebo controlled randomized trial
Anesthesiology, 2014Co-Authors: Faraj W Abdallah, Arkadiy Koshkin, Vincent W S Chan, S Abbas, Rajiv Gandhi, Richard BrullAbstract:BACKGROUND The analgesic efficacy of Sciatic Nerve Block (SNB) after total knee arthroplasty (TKA) is unclear. Proximal and distal SNB are each reported to provide posterior knee analgesia, whereas others suggest that posterior knee pain is not important after TKA. This prospective, randomized, double-blind, parallel-arm, placebo-controlled trial examined whether proximal or distal SNB provides superior analgesia in the posterior knee compared with no SNB after TKA. METHODS Sixty patients undergoing TKA were randomized to single-shot SNB using either the infragluteal (Proximal group) or popliteal (Distal group) technique, or no SNB (Placebo group). All patients received spinal anesthesia and continuous-femoral Nerve Blockade. A blinded observer assessed posterior and anterior knee pain at 2, 4, 6, 8, 12, and 24 h postoperatively. The primary outcome was moderate-to-severe posterior knee pain at 4 h postoperatively; secondary outcomes included SNB procedural time, needle passes, and discomfort. RESULTS Fifty-three patients were analyzed. The proportion of patients (Proximal:Distal:Placebo) who experienced moderate-to-severe posterior knee pain was 18%:22%:89% (P<0.00001) at 2 h, 24%:28%:72% (P<0.01) at 4 h, and 12%:17%:78% (P=0.00003) at 6 h postoperatively. For the anterior knee, the proportion of patients reporting moderate-to-severe pain was 6%:11%:44% (P=0.02) at 2 h, 6%:6%:39% (P=0.012) at 4 h, and 12%:6%:44% (P=0.017) at 6 h postoperatively. Moderate-to-severe pain did not differ between groups beyond 6 h. Both proximal and distal SNB reduced rest pain in the posterior and anterior knee up to 8 h postoperatively compared with no SNB. The popliteal technique required shorter procedural time, fewer needle passes, and produced less discomfort. CONCLUSION Proximal and distal SNB each reduce posterior and anterior knee pain after TKA compared with no SNB.
-
is circumferential injection advantageous for ultrasound guided popliteal Sciatic Nerve Block a proof of concept study
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Richard Brull, Alan Macfarlane, Arkadiy Koshkin, Simon J Parrington, Vincent W S ChanAbstract:Background: Ultrasound (US) guidance, in some instances, can increase the success rate and reduce the onset and procedure times for peripheral Nerve Blockade compared with traditional Nerve localization techniques. The presumptive mechanism for these benefits is the ability to accurately inject local anesthetic circumferentially around the target Nerve. We aimed to determine whether ensuring circumferential spread of local anesthetic is advantageous for US-guided popliteal Sciatic Nerve Block. Methods: Sixty-four adult patients undergoing US-guided popliteal Sciatic Block for elective foot and ankle surgery were randomly assigned to 1 of 2 groups, circumferential or single-location injection. Using a short-axis Nerve view and out-of-plane needle approach, the needle tip was advanced to the posterior external surface of the Sciatic Nerve. A 30-mL local anesthetic admixture (1:1 lidocaine 2%/bupivacaine 0.5% with 1:200,000 epinephrine) was injected either entirely at this location (single location) or incrementally at multiple locations to ensure circumferential spread around the Sciatic Nerve (circumferential). Sensory and motor functions were assessed by a blinded observer at predetermined intervals. The primary outcome was sensory Block defined as loss of sensation to pinprick in the distribution of both tibial and common peroneal Nerves at 30 mins after injection. Results: Sensory Block was achieved in 94% of patients in the circumferential injection group compared with 69% in the single-location injection group (P = 0.010). There were no differences detected in Block performance time, pain during Block performance, or Block-related complications between groups. Conclusions Ultrasound-guided circumferential injection of local anesthetic around the Sciatic Nerve at the popliteal fossa can improve the rate of sensory Block without an increase in Block procedure time or Block-related complications compared with a single-location injection technique.
-
ultrasound guidance improves the success of Sciatic Nerve Block at the popliteal fossa
Regional Anesthesia and Pain Medicine, 2008Co-Authors: Richard Brull, Vincent W S Chan, Anahi Perlas, Colin J L Mccartney, Alina Nuica, S AbbasAbstract:Background and Objectives Real time ultrasound guidance is a recent development in the area of peripheral Nerve Blockade. There are limited data from prospective randomized trials comparing its efficacy to that of traditional Nerve localization techniques. In the present study, we tested the hypothesis that ultrasound guidance improves the success rate of Sciatic Nerve Block at the popliteal fossa when compared with a Nerve stimulator-guided technique. Methods After Institutional Research Ethics Board approval and informed consent, 74 patients undergoing elective major foot or ankle surgery were randomly assigned to receive a Sciatic Nerve Block at the popliteal fossa guided by either ultrasonography (group US, transverse view, needle in plane approach above the Sciatic Nerve bifurcation), or Nerve stimulation (group NS, single injection, 10 cm proximal to the knee crease). A standardized local anesthetic admixture (15 mL of 2% lidocaine with 1:200,000 epinephrine and 15 mL of 0.5% bupivacaine) was used. Sensory and motor function was assessed by a blinded observer at predetermined intervals for up to 1 hour. Block success was defined as a loss of sensation to pinprick within 30 minutes in the distribution of both tibial and common peroneal Nerves. Results Group US had a significantly higher Block success rate than group NS (89.2% vs. 60.6%, P = .005), while the procedure time was similar. Conclusions Ultrasound guidance enhances the quality of popliteal Sciatic Nerve Block compared with single injection, Nerve stimulator-guided Block using either a tibial or peroneal endpoint. Ultrasound guidance resulted in higher success, faster onset, and progression of sensorimotor Block, without an increase in Block procedure time, or complications.
-
ultrasound imaging for popliteal Sciatic Nerve Block
Regional Anesthesia and Pain Medicine, 2004Co-Authors: A K Sinha, Vincent W S ChanAbstract:Abstract Background and objectives Ultrasound is a novel method of Nerve localization but its use for lower extremity Blocks appears limited with only reports for femoral 3-in-1 Blocks. We report a case series of popliteal Sciatic Nerve Blocks using ultrasound guidance to illustrate the clinical usefulness of this technology. Case report The Sciatic Nerve was localized in the popliteal fossa by ultrasound imaging in 10 patients using a 4- to 7-MHz probe and the Philips ATL HDI 5000 unit. Ultrasound imaging showed the Sciatic Nerve anatomy, the point at which it divides, and the spatial relationship between the peroneal and tibial Nerves distally. Needle contact with the Nerve(s) was further confirmed with Nerve stimulation. Circumferential local anesthetic spread within the fascial sheath after injection appears to correlate with rapid onset and completeness of Sciatic Nerve Block. Conclusions Our preliminary experience suggests that ultrasound localization of the Sciatic Nerve in the popliteal fossa is a simple and reliable procedure. It helps guide Block needle placement and assess local anesthetic spread pattern at the time of injection.
Gianluca Cappelleri - One of the best experts on this subject based on the ideXlab platform.
-
intraneural ultrasound guided Sciatic Nerve Block minimum effective volume and electrophysiologic effects
Anesthesiology, 2018Co-Authors: Gianluca Cappelleri, Valeria Cedrati, Marco Gemma, Andrea Luigi Ambrosoli, Federico Bizzarri, G DanelliAbstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Both extra- and intraneural Sciatic injection resulted in significant axonal Nerve damage. This study aimed to establish the minimum effective volume of intraneural ropivacaine 1% for complete sensory-motor Sciatic Nerve Block in 90% of patients, and related electrophysiologic variations. METHODS Forty-seven consecutive American Society of Anesthesiologists physical status I-II patients received an ultrasound-guided popliteal intraneural Nerve Block following the up-and-down biased coin design. The starting volume was 15 ml. Baseline, 5-week, and 6-month electrophysiologic tests were performed. Amplitude, latency, and velocity were evaluated. A follow-up telephone call at 6 months was also performed. RESULTS The minimum effective volume of ropivacaine 1% in 90% of patients for complete sensory-motor Sciatic Nerve Block resulted in 6.6 ml (95% CI, 6.4 to 6.7) with an onset time of 19 ± 12 min. Success rate was 98%. Baseline amplitude of action potential (mV) at ankle, fibula, malleolus, and popliteus were 8.4 ± 2.3, 7.1 ± 2.0, 15.4 ± 6.5, and 11.7 ± 5.1 respectively. They were significantly reduced at the fifth week (4.3 ± 2.1, 3.5 ± 1.8, 6.9 ± 3.7, and 5.2 ± 3.0) and at the sixth month (5.9 ± 2.3, 5.1 ± 2.1, 10.3 ± 4.0, and 7.5 ± 2.7) (P < 0.001 in all cases). Latency and velocity did not change from the baseline. No patient reported neurologic symptoms at 6-month follow-up. CONCLUSIONS The intraneural ultrasound-guided popliteal local anesthetic injection significantly reduces the local anesthetic dose to achieve an effective sensory-motor Block, decreasing the risk of systemic toxicity. Persistent electrophysiologic changes suggest possible axonal damage that will require further investigation.
-
effects of the intraneural and subparaneural ultrasound guided popliteal Sciatic Nerve Block a prospective randomized double blind clinical and electrophysiological comparison
Regional Anesthesia and Pain Medicine, 2016Co-Authors: Gianluca Cappelleri, Valeria Cedrati, Luisa Luciana Fedele, Marco Gemma, Laura Camici, Mario Loiero, Mauro Battista Gallazzi, Gabriele CornaggiaAbstract:Background and Objectives This prospective, randomized, double-blind study compared the effects of the ultrasound-guided popliteal Sciatic Nerve Block performed by either intraneural or subparaneural approach followed by an electrophysiological evaluation. We hypothesized that intraneural injection provides a faster onset with a better success rate compared with the subparaneural approach. Methods Eighty-eight patients were enrolled and randomized to receive an ultrasound-guided popliteal Sciatic Nerve Block injecting 15 mL ropivacaine 1% according to an intraneural injection (group INTRA = 44) or a subparaneural injection (group SUBPARA = 44). The primary end point was the onset time of sensory and motor Block, whereas secondary end points were successful, duration of the Block, and the variation of the electrophysiological assessment after 5 weeks. The study was registered prior to patient enrollment (clinicaltrials.gov identifier NCT01987128). Results The median onset time for successful Sciatic Nerve Block in the INTRA group was 10 (5–15 [5–30]) minutes versus 25 (15–35 [5–45]) minutes in the SUBPARA group (P Conclusions In ultrasound-guided popliteal Sciatic Nerve Block, intraneural injection provided a faster onset and better success rate compared with subparaneural. Both techniques resulted in a similar subclinical reduction in amplitude of the Sciatic action potentials at 5 weeks after surgery. These findings should not be extended to other approaches.
-
Does continuous Sciatic Nerve Block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study.
Regional anesthesia and pain medicine, 2011Co-Authors: Gianluca Cappelleri, Andrea Fanelli, Daniela Ghisi, Andrea Albertin, Francesco Somalvico, Giorgio AldegheriAbstract:Introduction: The aim of this prospective, randomized, double-blind study was to evaluate whether continuous Sciatic Nerve Block can improve postoperative pain relief and early rehabilitation compared with single-injection Sciatic Nerve Block in patients undergoing total knee arthroplasty (TKA) and lumbar plexus Block. Methods: After ethical committee approval and written informed consent, 38 patients with ASA physical status I to II were enrolled. The first group received continuous Sciatic and continuous lumbar plexus Blocks (group regional or R, n = 19), whereas the second group received a single Sciatic Nerve Block followed by saline infusion through the Sciatic catheter and continuous lumbar plexus Block (group control or C, n = 19). We assessed morphine consumption, scores for visual analog scale for pain at rest (VASr), and during continuous passive motion (VASi during CPM) for 48 hours postoperatively. Effectiveness of early ambulation was also evaluated. Results: Scores for VASr and VASi during CPM, as well as morphine consumption, were significantly higher in group C than in group R (P Conclusions: Continuous Sciatic Nerve Block improves analgesia, decreases morphine request, and improves early rehabilitation compared with single-injection Sciatic Nerve Block in patients undergoing TKA and lumbar plexus Block.
-
using stimulating catheters for continuous Sciatic Nerve Block shortens onset time of surgical Block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters
Anesthesia & Analgesia, 2005Co-Authors: Andrea Casati, Gianluca Cappelleri, Giorgio Aldegheri, G Fanelli, Regis Fuzier, Zbigniew J Koscielniaknielsen, G Danelli, Francois SingelynAbstract:We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal Sciatic Nerve Block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a Sciatic mediated muscular twitch at <= 0.5 mA Nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 ml, of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 2 min in Group S and 5 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor Blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184-508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal Sciatic Nerve Block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption.
Markus F Stevens - One of the best experts on this subject based on the ideXlab platform.
-
effects of early and late diabetic neuropathy on Sciatic Nerve Block duration and neurotoxicity in zucker diabetic fatty rats
BJA: British Journal of Anaesthesia, 2015Co-Authors: Philipp Lirk, Peter Gerner, Markus F Stevens, Camiel Verhamme, R Boeckh, Ten W Hoope, Stephan Blumenthal, U De Girolami, I N Van Schaik, Markus W HollmannAbstract:Background The neuropathy of type II diabetes mellitus (DM) is increasing in prevalence worldwide. We aimed to test the hypothesis that in a rodent model of type II DM, neuropathy would lead to increased neurotoxicity and Block duration after lidocaine-induced Sciatic Nerve Block when compared with control animals. Methods Experiments were carried out in Zucker diabetic fatty rats aged 10 weeks (early diabetic) or 18 weeks (late diabetic, with or without insulin 3 units per day), and age-matched healthy controls. Left Sciatic Nerve Block was performed using 0.2 ml lidocaine 2%. Nerve conduction velocity (NCV) and F-wave latency were used to quantify Nerve function before, and 1 week after Nerve Block, after which Sciatic Nerves were used for neurohistopathology. Results Early diabetic animals did not show increased signs of Nerve dysfunction after Nerve Block. In late diabetic animals without insulin vs control animals, NCV was 34.8 (5.0) vs 41.1 (4.1) ms s −1 ( P vs 7.0 (0.2) ms ( P Conclusions In a rodent type II DM model, Nerves have increased sensitivity for short-acting local anaesthetics without adjuvants in vivo , as evidenced by prolonged Block duration. This sensitivity appears to increase with the progression of neuropathy. Our results do not support the hypothesis that neuropathy due to type II DM increases the risk of Nerve injury after Nerve Block.
-
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, 2011Co-Authors: Jessica T Wegener, Markus W Hollmann, Bas Van Ooij, Niek C Van Dijk, Benedikt Preckel, Markus F StevensAbstract: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, 2011Co-Authors: Jessica T Wegener, Markus W Hollmann, Benedikt Preckel, Bas Van Ooij, Niek C Van Dijk, Markus F StevensAbstract: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.
Manoj K Karmakar - One of the best experts on this subject based on the ideXlab platform.
-
Case report Ultrasound-guided lumbar plexus Block through the acoustic window of the lumbar ultrasound trident
2015Co-Authors: Manoj K Karmakar, Wing H Kwok, K Tsang, W. Ngan D. KeeAbstract:Lumbar plexus Block (LPB) is frequently used in combination with an ipsilateral sacral plexus or Sciatic Nerve Block for lower limb surgery. This is traditionally performed using surface ana-tomical landmarks, and the site for local anaesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral Nerve stimulation. In this report, we describe a technique of ultrasound-guided LPB that was successfully used, in conjunction with a Sciatic Nerve Block, for anaesthesia during emergency lower limb surgery. The anatomy, sonographic features, technique of identifying the lumbar plexus, and the potential benefits of using this approach are discussed
-
ultrasound guided lumbar plexus Block through the acoustic window of the lumbar ultrasound trident
BJA: British Journal of Anaesthesia, 2008Co-Authors: Manoj K Karmakar, A M H Ho, Wing H Kwok, Xiang Li, K TsangAbstract:Abstract Lumbar plexus Block (LPB) is frequently used in combination with an ipsilateral sacral plexus or Sciatic Nerve Block for lower limb surgery. This is traditionally performed using surface anatomical landmarks, and the site for local anaesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral Nerve stimulation. In this report, we describe a technique of ultrasound-guided LPB that was successfully used, in conjunction with a Sciatic Nerve Block, for anaesthesia during emergency lower limb surgery. The anatomy, sonographic features, technique of identifying the lumbar plexus, and the potential benefits of using this approach are discussed.
-
combined paravertebral lumbar plexus and parasacral Sciatic Nerve Block for reduction of hip fracture in a patient with severe aortic stenosis
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2002Co-Authors: Manoj K KarmakarAbstract:Purpose To report the use of a combined paravertebral lumbar plexus and parasacral Sciatic Nerve Block for reduction of hip fracture in an elderly patient with severe aortic stenosis.