Year 2016 Vol. 24 No 6

ANESTHESIOLOGY-REANIMATOLOGY

V.G. PIACHERSKI, A.V. MARACHKOU

COMPARISON OF THE EFFICACY OF ULTRASOUND-GUIDED BLOCKADE OF THE SCIATIC NERVE PERFORMED THROUGH THREE APPROACHES: GLUTEAL, SUBGLUTEAL AND POPLITEAL

ME "Mogilev Regional Hospital",
Mogilev,
The Republic of Belarus

Objectives. Comparative assessment of the areas of sensory and motor block in blockade of the sciatic nerve, performed through three approaches: gluteal, subgluteal and popliteal.
Methods. In group A (n=31) the blockade was performed through the gluteal approach; in group B (n=193) – through the subgluteal access; in group C (n=32) – through the popliteal approach. All of the blockades of the sciatic nerve were performed with 30 ml of 1% lidocaine (epinephrine 1:200 000). Sensory block was evaluated in the foot, ankle joint, shin, popliteal fossa and posterior side of femur.
Results. In group A a complete motor block of the sciatic nerve occurred in all 31 patients. A complete sensor block was developed in all patients (100%) in the area of the foot, shin, popliteal fossa, posterior side of the thigh. Complete motor blockade of the sciatic nerve was obtained in all patients in the area of the foot, shin, popliteal fossa, posterior side of the thigh. In group B a complete sensor block in the area of the foot, shin occurred in all patients. In the popliteal fossa area a complete sensory block developed in no patient, a partial block occurred in 143 patients (74,8%) and in 50 patients (25,2%) the sensor block didn’t developed at all. In group B a sensor block in the lower, middle and upper third of the thigh developed in no patient. In group C a complete sensory block in all 32 patients developed only in the area of the foot, ankle joint and lower third of the thigh. Complete motor block wasn’t registered in any patient.
Conclusion. When the sciatic nerve is blocked by the subgluteal approach, the complete sensor block doesn’t develop in the popliteal fossa and posterior side of the thigh. Using the popliteal approach, the sensor block occurs only in the area of the foot, ankle joint and lower third of the tibia. When the sciatic nerve is blocked through the gluteal approach, the sensor block develops in the area of the foot, shin, popliteal fossa and lower third of the tibia.

Keywords: sciatic nerve, peripheral block, US-control, gluteal approach, subgluteal approach, popliteal approach, incisional period
p. 586-591 of the original issue
References
  1. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010 May;104(5):538-46. doi: 10.1093/bja/aeq069.
  2. Tran DQ, Bertini P, Zaouter C, Muñoz L, Finlayson RJ. A prospective, randomized comparison between single- and double-injection ultrasound-guided infraclavicular brachial plexus block. Reg Anesth Pain Med. 2010 Jan-Feb;35(1):16-21. doi: 10.1097/AAP.0b013e3181c7717c.
  3. Brull R, Macfarlane AJ, Parrington SJ, Koshkin A, Chan VW. Is circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block?: A proof-of-concept study. Reg Anesth Pain Med. 2011 May-Jun;36(3):266-70. doi: 10.1097/AAP.0b013e318217a6a1.
  4. Latzke D, Marhofer P, Zeitlinger M, Machata A, Neumann F, Lackner E, et al. Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth. 2010 Feb;104(2):239-44. doi: 10.1093/bja/aep368.
  5. Brukhnov AV, Pecherskii VG, Marochkov AV, Kokhan ZV. Obosnovanie taktiki anesteziologicheskogo obespecheniia u patsientov pri khirurgicheskikh vmeshatel'stvakh na verkhnikh konechnostiakh [Substantiation of tactics of anesthesia in patients undergoing surgical procedures on upper extremities]. Khirurgiia Vostochnaia Evropa. 2014;(2):79-89.
  6. Rafmell DR, Nil DM, Viskoumi KM. Regionarnaia anesteziia. Samoe neobkhodimoe v anesteziologii [Regional anesthesia. The most important thing in anesthesiology]. Moscow, RF: MEDpress-inform; 2008. 272 p.
  7. Iliukevich GV, Oletskii VE. Regionarnaia anesteziia [Regional anesthesia]. Minsk, RB: Kovcheg; 2006. 164 p.
  8. Chelly JE. Peripherial nerve blocks: a color atlas. 3rd ed. Hardcover; 2009. 496 p.
  9. Dufour E, Quennesson P, Van Robais AL, Ledon F, Laloe PA, Liu N, et al. Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesth Analg. 2008 May;106(5):1553-8, table of contents. doi: 10.1213/ane.0b013e3181684b42.
  10. Eldegwy MH, Ibrahim SM, Hanora S, Elkarta E, Elsily AS. Ultrasound-guided sciatic politeal nerve block: a comparison of separate tibial and common peroneal nerve injections versus injecting proximal to the bifurcation. Middle East J Anaesthesiol. 2015 Jun;23(2):171-76.
  11. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 2–Recent developments in block techniques. BJA. 2010;104(Is 6):673-83.
  12. Piacherski V, Marochkov A. Features and principles the spread of local anesthetic blockade of the sciatic nerve at depends on the amount of anesthetic. OJAnes. 2014 Feb;14(2):31-35 doi: 10.4236/ojanes.2014.42004.
  13. Sinel'nikov RD. Atlas anatomii cheloveka. Tom 3: Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [Atlas of Human Anatomy. Vol. 3: The doctrine of the nervous system, sensory organs and endocrine organs]. Moscow, RF: Meditsina; 1974. 399 p.
  14. Ostroverkhov GE, Bomash IuM, Lubotskii DN. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. 4-e izd dop. Kursk, RF: Kursk; 1995. 720 p.
  15. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, RF: Meditsina; 1977. 416 p.
  16. Moayeri N, Groen GJ. Differences in quantitative architecture of sciatic nerve may explain differences in potential vulnerability to nerve injury, onset time, and minimum effective anesthetic volume. Anesthesiology. 2009 Nov;111(5):1128-34. doi: 10.1097/ALN.0b013e3181bbc72a.
Address for correspondence:
212026, Republic of Belarus,
Mogilev, Bolshaya-Birulya st.,
12, ME "Mogilev Regional Hospital",
Department of anesthesiology
and intensive care.
Tel.: + 375 212 37-80-82
E-mail: pechersky.v@yandex.by
Pecherskiy Valery Gennadevich
Information about the authors:
Piacherski V.G. PhD, Anesthesiologist of the department of anesthesiology and reanimation, ME "Mogilev Regional Hospital".
Marachkou A.V. MD, Professor, Head of the department of anesthesiology and reanimation, ME "Mogilev Regional Hospital".
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