Distale Blockaden des N. ischiadicus

Seidel, R.D.; Natge, Ulrich; Schulz, Joachim

doi:10.1007/s00101-013-2150-5

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…While the generally recommended stimulation current is 0.3–0.5 mA, 3 this threshold or even higher currents cannot exclude intraneural needle placement. 4 – 8 The choice of stimulation current level may be of particular importance when performing PNS in patients with pre-existing neurological deficits, such as diabetic neuropathy. Reports have shown increased stimulation thresholds for diabetic patients, including patients in which no motor response to PNS could be obtained with 2.4 mA, despite clear needle-nerve contact witnessed by ultrasound (US).…”

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confidence: 99%

Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block

Heschl

Hallmann

Zilke

et al. 2016

British Journal of Anaesthesia

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BackgroundPeripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3–0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes.MethodsPreoperative evaluation included a neurological exam and electroneurography. During ultrasound-guided popliteal sciatic nerve block, we measured the current required to produce motor activity for the tibial and common peroneal nerve in diabetic and non-diabetic patients. Proximity to the nerve was evaluated post-hoc using ultrasound imaging.ResultsAverage stimulation currents did not differ between diabetic (n=55) and non-diabetic patients (n=52). Although the planned number of patients was not reached, the power goal for the mean stimulation current was met. Subjects with diminished pressure perception showed increased thresholds for the common peroneal nerve (median 1.30 vs. 0.57 mA in subjects with normal perception, P=0.042), as did subjects with decreased pain sensation (1.60 vs. 0.50 mA in subjects with normal sensation, P=0.038). Slowed ulnar nerve conduction velocity predicted elevated mean stimulation current (r=−0.35, P=0.002). Finally, 15 diabetic patients required more than 0.5 mA to evoke a motor response, despite intraneural needle placement (n=4), or required currents ≥2 mA despite needle-nerve contact, vs three such patients (1 intraneural, 2 with ≥2 mA) among non-diabetic patients (P=0.003).ConclusionsThese findings suggest that stimulation thresholds of 0.3–0.5 mA may not reliably determine close needle-nerve contact during popliteal sciatic nerve block, particularly in patients with diabetic neuropathy.Clinical trial registrationNCT01488474

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confidence: 99%

Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block

Heschl

Hallmann

Zilke

et al. 2016

British Journal of Anaesthesia

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“…The data acquired by R.Seidel confirm that the introduction of local anesthetic under the epinevry of the sciatic nerve (popliteal access) involves faster developing anesthesia than the introduction of local anesthetic extraparaneuraly [22]. Although in this paper the introduction of anesthetic subparaneuraly ("subepimyseal perineural compartment") is not discussed, it is described in other studies [15].…”

Section: Discussionmentioning

confidence: 55%

Comparison of Time Development of the Sciatic Nerve Blockade Performed with 1% Lidocaine Subgluteal and Popliteal Approach under Ultrasound Guidance

Valery¹,

Aliaksei²,

Brukhnou³

et al. 2014

OJAnes

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The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in comparison with subgluteal sciatic nerve blockade. Background: The aim of the research is to compare the time of the development of the sciatic nerve blockade performed with 1% lidocaine with epinephrine (1:200,000) in subgluteal and popliteal areas under ultrasound guidance. Materials and Methods: Patients were divided into two groups. In Group A (20 patients), the subgluteal approach to block the sciatic nerve was taken; in Group B (20 patients), the popliteal approach was applied. All blockades of the sciatic nerve were performed with 1% lidocaine (30 ml of lidocaine with epinephrine (1:200,000)) and electrical stimulation of peripheral nerves under ultrasound guidance. We measured the time of the development of sensory and motor blocks. Results: In Group A, the sciatic nerve sensory block developed in 15 (14 -16) minutes, a complete motor block developed in 15.5 (15 -17) minutes. In Group B the sciatic nerve sensory block developed in 40 (38.5 -42.5) minutes while a complete motor block did not develop in any patient. Conclusion: When the sciatic nerve is blocked in subgluteal area with 30 ml of 1% lidocaine with epinephrine (1:200,000) under ultrasound guidance, sensory blocks develop faster than during the popliteal blockade: 15 (14 -16) minutes vs. 40 (38.5 -42.5) minutes respectively. The opportunity to define the place of the introduction of local anesthetic in our research is limited.

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“…The disappearance of motor responses at > 0.5 mA is also associated with intraneural location of the needle tip; in supraclavicular blocks in 10% of cases and even in 90% (!) of cases in popliteal sciatic blocks [59][60][61][62][63]. The lack of motor response to markedly higher current intensities (1.5 mA) does not exclude intraneural location of the needle tip [61].…”

Section: Safety Of Nerve Location Methods Nerve Stimulationmentioning

confidence: 99%

Uszkodzenie nerwu jako powikłanie znieczulenia nerwów obwodowych

Pietraszek¹

2018

Anaesthesiol Intensive Ther

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Regional anaesthesia techniques have gained great popularity in recent years, as they provide excellent anaesthesia and analgesia for many surgical procedures. Many courses, workshops, multimedia materials and a wide access to high-end ultrasound devices have resulted in Polish anaesthesiologists eagerly performing various blockades. However, there is also a dark side to regional anaesthesia which should not be forgotten-complications. Although nerve injuries are considered to be multifactorial in nature and the vast majority of them are not due to regional anaesthesia, anaesthesiologists and anaesthetised patients must be aware of the risk involved. Due to the potentially devastating sequelae of regional blocks, updating one's knowledge of this topic is very much necessary. The aim of this review is to summarise current knowledge concerning regional anaesthesia-induced peripheral nerve injury.

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Distale Blockaden des N. ischiadicus

Cited by 11 publications

References 33 publications

Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block

Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block

Comparison of Time Development of the Sciatic Nerve Blockade Performed with 1% Lidocaine Subgluteal and Popliteal Approach under Ultrasound Guidance

Uszkodzenie nerwu jako powikłanie znieczulenia nerwów obwodowych

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