Electrical Stimulation Versus Ultrasound Guidance for Popliteal-Sciatic Perineural Catheter Insertion: A Randomized Controlled Trial. Issue 5 (1st August 2009)

• Record Type: Journal Article
• Authors: Mariano, Edward R.; Cheng, Gloria S.; Choy, Lynna P.; Loland, Vanessa J.; Bellars, Richard H.; Sandhu, NavParkash S.; Bishop, Michael L.; Lee, Daniel K.; Maldonado, Rosalita C.; Ilfeld, Brian M.
• Is Part Of: Regional anesthesia and pain medicine. Volume 34:Issue 5(2009)
• Page Start: 480-485
• Page End: 480-485
• Publication Date: 2009-08-01
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1097/AAP.0b013e3181ada57a
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background: Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES. Methods: Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot and/or ankle surgery were randomly assigned to either the ES with a stimulating catheter or US-guided technique with a nonstimulating catheter. The primary end point was catheter insertion duration (in minutes) starting when the US transducer (US group) or catheter-placement needle (ES group) first touched the patient and ending when the catheter-placement needle was removed after catheter insertion. Results: All US-guided catheters were placed per protocol (n = 20), whereas only 80% of stimulation-guided catheters could be placed per protocol (n = 20, P = 0.106). All catheters placed per protocol in both groups resulted in a successful surgical block. Perineural catheters placed by US took a median (10th-90th percentile) of 5.0 min (3.9-11.1 min) compared with 10.0 min (2.0-15.0 min) for stimulation ( P = 0.034). Subjects in the US group experienced less pain during catheter placement, scoring discomfort a median of 0 (0.0-2.1) compared with 2.0 (0.0-5.0) for the stimulation group ( P = 0.005) on a numeric rating scale of 0 to 10. Conclusions: Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.