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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...

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A randomized comparison between bifurcation and prebifurcation subparaneural popliteal sciatic nerve blocks.

De Q H Tran1, Andrea P González, Francisca Bernucci

  • 1From the Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.

Anesthesia and Analgesia
|March 16, 2013
PubMed
Summary

Ultrasound-guided popliteal sciatic nerve blocks at the prebifurcation (PB) or bifurcation (B) site showed similar success rates and anesthesia times. This study found no significant difference between the two techniques for popliteal sciatic nerve blocks.

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Ultrasound-Guided Procedures

Background:

  • Prospective, randomized, observer-blinded trial comparing two ultrasound-guided popliteal sciatic nerve block techniques.
  • Investigated blocks performed at or proximal to the neural bifurcation (B) versus a prebifurcation (PB) approach.
  • Hypothesized that the prebifurcation technique would decrease total anesthesia-related time.

Purpose of the Study:

  • To compare the efficacy and efficiency of prebifurcation (PB) versus bifurcation (B) ultrasound-guided popliteal sciatic nerve blocks.
  • To determine if the PB technique reduces total anesthesia-related time (performance and onset).

Main Methods:

  • 68 patients underwent ultrasound-guided posterior popliteal sciatic nerve block with identical local anesthetic volume and composition.
  • PB group: injection at the common sciatic trunk, distal to bifurcation.
  • B group: injection between tibial and peroneal divisions, within the paraneural sheath.

Main Results:

  • Comparable success rates (85%-88%) and total anesthesia-related times (23.4-26.0 minutes) between PB and B groups.
  • Similar performance times, onset times, number of needle passes, and incidence of paresthesia.
  • No significant difference in sonographic neural swelling or adverse events.

Conclusions:

  • Ultrasound-guided popliteal sciatic nerve blocks at the prebifurcation (PB) or bifurcation (B) site yield comparable success rates and total anesthesia-related times when injected within the paraneural sheath.
  • While differences were not statistically significant, confidence intervals suggest potential undetected variations in success rate and total time.