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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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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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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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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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A Randomized Comparison Between Single- and Triple-Injection Subparaneural Popliteal Sciatic Nerve Block.

Worakamol Tiyaprasertkul1, Francisca Bernucci, Andrea P González

  • 1From the *Maharaj Nakorn Chiang Mai Hospital, Department of Anesthesia, Chiang Mai University, Chiang Mai, Thailand; †Department of Anesthesia, Hospital de Carabineros, Santiago, Chile; and ‡Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada.

Regional Anesthesia and Pain Medicine
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Summary

Single-injection (SI) and triple-injection (TI) ultrasound-guided popliteal sciatic nerve blocks show similar success rates and anesthesia times. The SI technique requires fewer needle passes for effective pain management.

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Ultrasound-Guided Procedures

Background:

  • The subparaneural popliteal sciatic nerve block is a regional anesthesia technique.
  • The paraneurium's role in entrapping local anesthetic (LA) suggests single injection may suffice.
  • This study investigated the efficacy of single versus multiple injections in this block.

Purpose of the Study:

  • To compare ultrasound-guided single-injection (SI) and triple-injection (TI) subparaneural popliteal sciatic nerve blocks.
  • To test the hypothesis that single injection is sufficient due to the paraneurium's LA-entrapping properties.
  • To evaluate success rates and total anesthesia-related times as primary outcomes in an equivalency trial.

Main Methods:

  • A prospective randomized trial involving 100 patients undergoing ultrasound-guided subparaneural popliteal sciatic nerve block.
  • Patients were randomized to either SI (one injection site) or TI (three injection sites) with identical LA volume and mixture.
  • Outcomes included success rate, onset time, performance time, needle passes, and adverse events.

Main Results:

  • Both SI and TI techniques demonstrated comparable success rates (92%) and total anesthesia-related times (17.1-19.7 minutes).
  • The SI group required significantly fewer needle passes (1 vs 3; P < 0.001) and shorter needling time (P = 0.025).
  • The TI group had a shorter onset time (P = 0.027), while performance time and adverse events were similar.

Conclusions:

  • Ultrasound-guided SI and TI subparaneural popliteal sciatic nerve blocks achieve comparable success rates and total anesthesia-related times.
  • The SI technique is advantageous due to fewer needle passes.
  • These findings support the efficacy of single-injection subparaneural popliteal sciatic nerve blocks.