Popliteal Sciatic Nerve Block
Conditions
Brief summary
Sensory and motor innervation below the knee is provided mainly by the popliteal-sciatic nerve except for a variable area of the medial leg supplied by the saphenous nerve. Regional anaesthesia and analgesia for below knee surgery are frequently provided by blocking the popliteal sciatic nerve in the popliteal fossa. Popliteal sciatic block was first introduced around the 1970s and has emerged as a popular technique for below knee surgery despite other types of lower limb peripheral nerve block. This is contributed because popliteal fossa offers a superficial and accessible location for nerve blockade. This anatomical feature simplifies the procedure and may reduce the risk of complications such as vascular puncture or nerve injury. Analgesia provided by the popliteal sciatic block lasts significantly longer than with ankle blocks. One of the reasons is administration of local anaesthetic agent at the popliteal fossa allows it to bathe the sciatic nerve before it bifurcates into the tibial and common peroneal nerves, leading to a more extensive and prolonged nerve blockade. Besides the sciatic nerve at the popliteal level is encased in a common epineural sheath, which can facilitate the spread of the anaesthetic and prolong its effect. The popliteal sciatic block can be performed as a single-shot technique or as a continuous infusion via a catheter The success rate of popliteal sciatic block is dependent on several variables, including the operator's skill, patient considerations, and surgical variables. This study comparing between 2 approaches of popliteal sciatic nerve ie: classical approach and relatively new approach that is crosswise approach of popliteal sciatic nerve (CAPS) block.
Interventions
PROCEDUREPopliteal Plexus Block with 20 ml
Different position while blocking the popliteal sciatic nerve block
Sponsors
National University of Malaysia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* planned for either elective or non-elective unilateral below-knee surgery at HUKM * patients aged 18 years and older and classified as physical status I, II, or III as dictated by the American Society of Anaesthesiologists (ASA)
Exclusion criteria
* included pregnant patients, those with a body mass index (BMI) ≥40 kg/m², contraindicated to peripheral nerve block (such as existing nerve injury to the limb intended for surgery), patient refusal, severe coagulopathy, local anaesthetic (LA) allergy, active infection at the intended block site, patients unable to provide a pain score using a verbal numerical rating scale (VNRS)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain score during positioning and block performance | Time from positioning and block performance until completion of block (preoperative). | Using verbal numerical rating scale (VNRS),ranging from 0 to 10, where 0 = no pain and 10 = the worst pain imaginable. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fentanyl consumption | On operative day until post operative day 1 | Aliquots of intravenous (IV) fentanyl (25-50 micrograms) were given if the patient experienced pain with a VNRS ≥4 during positioning or block performance. |
| Onset of block | Immediately after block completion until 30 minutes after. | Adequacy of the block was assessed at 5-minute intervals based on the loss of pain sensation to pin prick with a 23G (B. Braun®) needle in the distribution of the popliteal sciatic nerve (measure in minutes). |
| Failure rate | 30 minutes after block completion | Persistent pain sensation after 30 minutes over popliteal sciatic nerve distribution |
| Patient's satisfaction | One day after procedure. | Patient satisfaction with the block was assessed using a five-point Likert scale (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied). |
| Complications | On operative day until post operative day 1 | Such as hematoma, L.A toxicity, or persistent numbness/weakness lasting more than 24 hours. |
Countries
Malaysia
Outcome results
None listed