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Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block

BACKGROUND: Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is...

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Autores principales: Bowens, Clifford, Badiola, Ignacio J., Allen, Brian Frazer Scott, Canlas, Christopher Loredo, Gupta, Rajnish Kumar, Jaeger, Lisa Michelle, Briggs, Eric Russell, Corey, John Matthew, Shi, Yaping, Schildcrout, Jonathan Scott, Malchow, Randall John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672631/
https://www.ncbi.nlm.nih.gov/pubmed/34906248
http://dx.doi.org/10.1186/s13741-021-00229-w
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author Bowens, Clifford
Badiola, Ignacio J.
Allen, Brian Frazer Scott
Canlas, Christopher Loredo
Gupta, Rajnish Kumar
Jaeger, Lisa Michelle
Briggs, Eric Russell
Corey, John Matthew
Shi, Yaping
Schildcrout, Jonathan Scott
Malchow, Randall John
author_facet Bowens, Clifford
Badiola, Ignacio J.
Allen, Brian Frazer Scott
Canlas, Christopher Loredo
Gupta, Rajnish Kumar
Jaeger, Lisa Michelle
Briggs, Eric Russell
Corey, John Matthew
Shi, Yaping
Schildcrout, Jonathan Scott
Malchow, Randall John
author_sort Bowens, Clifford
collection PubMed
description BACKGROUND: Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success. METHODS: Eighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 min after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%). RESULTS: The degree of nerve blockade at 30 min as judged by median (10th, 90th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02). CONCLUSIONS: Injection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound. TRIAL REGISTRATION: NCT01591603
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spelling pubmed-86726312021-12-17 Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block Bowens, Clifford Badiola, Ignacio J. Allen, Brian Frazer Scott Canlas, Christopher Loredo Gupta, Rajnish Kumar Jaeger, Lisa Michelle Briggs, Eric Russell Corey, John Matthew Shi, Yaping Schildcrout, Jonathan Scott Malchow, Randall John Perioper Med (Lond) Research BACKGROUND: Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success. METHODS: Eighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 min after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%). RESULTS: The degree of nerve blockade at 30 min as judged by median (10th, 90th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02). CONCLUSIONS: Injection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound. TRIAL REGISTRATION: NCT01591603 BioMed Central 2021-12-15 /pmc/articles/PMC8672631/ /pubmed/34906248 http://dx.doi.org/10.1186/s13741-021-00229-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bowens, Clifford
Badiola, Ignacio J.
Allen, Brian Frazer Scott
Canlas, Christopher Loredo
Gupta, Rajnish Kumar
Jaeger, Lisa Michelle
Briggs, Eric Russell
Corey, John Matthew
Shi, Yaping
Schildcrout, Jonathan Scott
Malchow, Randall John
Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title_full Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title_fullStr Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title_full_unstemmed Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title_short Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
title_sort color doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672631/
https://www.ncbi.nlm.nih.gov/pubmed/34906248
http://dx.doi.org/10.1186/s13741-021-00229-w
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