RESUMO
We compared the effect of two different positions of a sciatic nerve catheter within the popliteal fossa on local anaesthetic consumption and postoperative analgesia in patients undergoing day-case hallux valgus repair. Eighty-four patients were randomly allocated to receive a sciatic nerve catheter either between the tibial and peroneal components (sciatic group) or medial to the tibial nerve (tibial group). The primary endpoint was postoperative local anaesthetic consumption, while secondary endpoints were pain scores, number of occasions where sleep was disturbed by pain and incidence of insensate limb and foot drop at 24 h and 48 h postoperatively. Postoperative median (IQR [range]) local anaesthetic consumption was 126 (106-146 [98-180]) ml in the sciatic group versus 125 (114-158 [98-200]) ml in the tibial group (p = 0.103). Insensate limb occurred in 14 patients in the sciatic group versus one patient in the tibial group (p < 0.001), while foot drop was reported by six patients in the sciatic group and none in the tibial group (p = 0.012). Sciatic nerve catheter placement medial to the tibial nerve may be a superior analgesic technique for day-case foot surgery.
Assuntos
Hallux Valgus/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Nervo Isquiático/diagnóstico por imagem , Método Simples-Cego , Nervo Tibial/diagnóstico por imagem , Ultrassonografia de Intervenção/métodosRESUMO
We allocated 100 patients scheduled for day-case knee arthroscopy to unilateral spinal anaesthesia with 40 mg intrathecal hyperbaric prilocaine or to ultrasound-guided femoral-sciatic nerve blockade with 25 ml mepivacaine 2%, 50 participants each. The median (IQR [range]) time to walk was 285 (240-330 [160-515]) min after intrathecal anaesthesia vs 328 (280-362 [150-435]) min after peripheral nerve blockade, p = 0.007. The median (IQR [range]) time to home discharge was 310 (260-350 [160-520]) min after intrathecal anaesthesia vs 335 (290-395 [190-440]) min after peripheral nerve blockade, p = 0.016. There was no difference in time from anaesthetic preparation to readiness for surgery.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestésicos Locais/uso terapêutico , Artroscopia , Injeções Espinhais , Articulação do Joelho/cirurgia , Bloqueio Nervoso/métodos , Adolescente , Adulto , Idoso , Período de Recuperação da Anestesia , Anestésicos Locais/administração & dosagem , Feminino , Nervo Femoral/diagnóstico por imagem , Nervo Femoral/efeitos dos fármacos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Mepivacaína/administração & dosagem , Mepivacaína/uso terapêutico , Pessoa de Meia-Idade , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/efeitos dos fármacos , Prilocaína/administração & dosagem , Prilocaína/uso terapêutico , Nervo Isquiático/diagnóstico por imagem , Nervo Isquiático/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto JovemRESUMO
The aim of this randomised, prospective, blinded study was to evaluate if stimulating catheters can decrease the minimum effective anaesthetic volume in 50% of patients during lumbar plexus block using mepivacaine 1.5% compared with standard catheters. Fifty-eight patients of ASA physical status 1-3 were randomly allocated to receive a lumbar plexus block via a stimulating or standard catheter, with 29 in each group. The first dose was 30 ml and subsequent doses were determined using the up-and-down staircase method. The minimum effective anaesthetic volume50 was 12.2 ml (95% CI 7.3-17.1 ml) using the stimulating catheter and 24.8 ml (95% CI 23.2-27.5 ml) with the standard catheter (p < 0.0001). Complete lumbar plexus block was achieved with the initial dose of mepivacaine in 29 (100%) patients in the stimulating catheter group and 20 (69%) patients in the standard catheter group (p = 0.002). This study showed that use of a stimulating catheter halves the minimum effective anaesthetic volume50 of mepivacaine 1.5% while increasing the success rate in patients receiving continuous lumbar plexus block.
