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Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery?
Régis Fuzier1, Pierre Hoffreumont, Sophie Bringuier-Branchereau
1*Department of Anesthesiology, Université Catholique de Louvain School of Medicine, Brussels, Belgium; †Clinique Saint Pierre, Ottignies, Belgium; ‡Department of Anesthesiology, Hôpital Lapeyronie, Montpellier, France.
Anesthesia and Analgesia
|April 23, 2005
Summary
The posterior popliteal approach for sciatic nerve blocks is more comfortable than Labat's approach for below-knee surgery. Both methods offer comparable surgical success, but the popliteal technique is preferred for patient comfort.
Area of Science:
- Anesthesiology
- Surgical Procedures
- Pain Management
Background:
- Below-knee surgery often requires effective anesthesia and tourniquet tolerance.
- Sciatic nerve blocks are crucial for lower limb anesthesia, with various approaches available.
- Patient comfort during nerve block procedures is an important consideration.
Purpose of the Study:
- To compare thigh tourniquet tolerance between Labat's and posterior popliteal sciatic nerve block approaches.
- To evaluate patient comfort during the performance of these sciatic nerve blocks.
- To assess the efficacy and success rates of both block techniques for below-knee surgery.
Main Methods:
- Prospective, randomized, blinded study involving 120 patients undergoing below-knee surgery.
- Patients were divided into two groups: Group 1 (posterior popliteal approach) and Group 2 (Labat's approach).
- Both groups received a sciatic nerve block with mepivacaine and epinephrine, plus a femoral nerve block. Comfort, sensory block, success rate, and tourniquet tolerance were recorded.
Main Results:
- Block performance was significantly more comfortable in the posterior popliteal group (Group 1) compared to Labat's group (Group 2) (P < 0.01).
- Completeness of sensory block at 30 minutes and overall success rates were similar between the two groups.
- Thigh tourniquet pain increased over time in both groups, with no statistically significant difference observed between the approaches.
Conclusions:
- The posterior popliteal sciatic nerve block approach is more comfortable for patients than Labat's approach.
- Despite complete sensory blockade of the posterior femoral cutaneous nerve in 91% of patients, Labat's approach did not improve tourniquet tolerance.
- The posterior popliteal approach is as effective as Labat's for below-knee surgery and is the preferred technique due to superior patient comfort.