Subparaneural versus circumferential extraneural injection at the bifurcation level in ultrasound-guided popliteal sciatic nerve blocks: a prospective, randomized, double-blind study.

Background: The ideal spread of local anesthetic for effective, rapid, and safe sciatic nerve block is debated. We hypothesized that subparaneural ultrasound-guided injection results in faster onset and has a better success rate than extraneural circumferential spread.

Methods: Patients undergoing elective tibial, foot, and ankle surgery with popliteal sciatic nerve blocks were prospectively enrolled.

A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block.

Background: Fractured neck of femur generally requires operative fixation and is a common cause of admission to hospital. The combination of femoral nerve block and spinal anesthesia is a common anesthetic technique used to facilitate the surgical procedure. The optimal disposition of local anesthetic (LA) relative the femoral nerve (FN) has not been defined.

Where should the tip of the needle be located in ultrasound-guided peripheral nerve blocks?

Purpose Of Review: Data now exist describing the appropriate positioning of the needle tip and pattern of local anaesthetic spread after injection. The recent literature has been analysed in search of studies on the optimal procedure for common approaches centred on block efficacy, performance time, and safety.

Recent Findings: Large peripheral nerves are surrounded by a gliding layer, the adventitia or paraneurium.

Hemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities.

Background And Objectives: The impact of anesthesia techniques in patients experiencing hip fracture is controversial. This study compares the effects on blood pressure of 3 anesthesia techniques that are considered safe for the elderly.

Methods: Forty-five patients older than 75 years, with American Society of Anesthesiologists physical status III or IV, with cardiac comorbidities, and undergoing surgery for hip fracture, were randomized to receive continuous spinal anesthesia (CSA), propofol target-controlled infusion (TCI), or sevoflurane (SEVO).

Femoral nerve blockade.

Femoral nerve blockade is the most widely performed lower limb block. Methods of femoral nerve blockade are briefly reviewed with particular reference to ultrasound guidance.

Ultrasound-guided evaluation of the local anesthetic spread parameters required for a rapid surgical popliteal sciatic nerve block.

Background: The ideal spread of local anesthetic (LA) solution around the sciatic nerve during a popliteal block remains unclear. We tested the hypothesis that a circumferential spread of LA and/or intraneural injection could lead to rapid surgical block.

Methods: Patients (n = 100) scheduled for foot or ankle surgery underwent popliteal sciatic nerve block using nerve stimulation according to Borgeat's technique and injection of ropivacaine (0.

The ultrasound-guided transversus abdominis plane block for anterior iliac crest bone graft postoperative pain relief: a prospective descriptive study.

Background: Acute postoperative pain and nerve injuries frequently lead to neuropathic chronic pain after anterior iliac crest (AIC) bone graft. This prospective study evaluated postoperative pain relief after preoperative ultrasound-guided transversus abdominis plane (TAP) block for orthopedic surgery with an AIC bone harvest and the prevalence of pain chronicization at 18 months after surgery.

Methods: Thirty-three consecutive patients scheduled for major orthopedic surgery with an AIC harvest for autologous bone graft were studied.

Age-dependent bupivacaine-induced muscle toxicity during continuous peripheral nerve block in rats.

Background: Regional blocks improve postoperative analgesia and postoperative rehabilitation in children and adult patients. Continuous peripheral nerve blocks have been proposed as safe and effective techniques for postoperative pain relief and chronic pain therapy, particularly in small children. Few clinical reports have described myotoxicity induced by bupivacaine in these young patients, in contrast with a larger number of observations in adults.

Effects of intermittent femoral nerve injections of bupivacaine, levobupivacaine, and ropivacaine on mitochondrial energy metabolism and intracellular calcium homeostasis in rat psoas muscle.

Background: Long-acting local anesthetics cause muscle damage. Moreover, long-acting local anesthetics act as uncoupler of oxidative phosphorylation in isolated mitochondria and enhance sarcoplasmic reticulum Ca(2+) release. The aim of the study was to evaluate effects of perineural injections of local anesthetics on mitochondrial energetic metabolism and intracellular calcium homeostasis in vivo.

Postoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study.

Background: The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial.

Methods: Forty-five patients were assigned to 1 of 3 groups, patient-controlled analgesia with morphine (PCA), femoral nerve block (FNB), or psoas compartment block (PCB). At the end of the procedure performed under general anesthesia, nerve blocks using 2 mg/kg of 0.

Comparison of continuous 3-in-1 and fascia Iliaca compartment blocks for postoperative analgesia: feasibility, catheter migration, distribution of sensory block, and analgesic efficacy.

Background And Objectives: Efficacy and technical aspects of continuous 3-in-1 and fascia iliaca compartment blocks were compared.

Methods: Forty-four patients scheduled for cruciate ligament repair or femur surgery were randomly divided into 2 groups. After surgery with the patient anesthetized, catheters were placed for continuous 3-in-1 blocks by means of a nerve stimulator (group 1).

Continuous three-in-one block for postoperative pain after lower limb orthopedic surgery: where do the catheters go?

Unlabelled: Continuous three-in-one block is widely used for postoperative analgesia after proximal lower limb surgery, but location of the catheter has not been well addressed in the literature. We prospectively studied, in 100 patients, the characteristics of catheter threading under the iliac fascia and the correlations between catheter tip location and effective sensory and motor blockade of the three principal nerves of the lumbar plexus. Postoperatively, in conscious patients, 16 to 20 cm of a catheter was placed in the fascial sheath after femoral nerve location with a nerve stimulator.