Is a double-injection technique superior to a single injection in posterior subgluteal sciatic nerve block?

Background For peripheral nerve blockade, the double-injection technique proved to be superior to a single injection in previous investigations. The current study was designed to compare onset time and efficacy of two different double-injection approaches for sciatic nerve block with 0.75% ropivacaine. Methods A total of 50 patients undergoing foot surgery were randomly assigned to receive sciatic nerve blockade by means of the classic (Labat) posterior approach (n = 25) or a lateral popliteal approach (n = 25). All blocks were performed with the use of a nerve stimulator, and both major components of the sciatic nerve (tibial and common peroneal nerves) received separately 10 ml ropivacaine, 0.75%. Success rate was defined as a complete sensory and motor block associated with pain-free surgery. Results A greater success rate was observed in the classic group (96%) as compared with the popliteal group (68%; P < 0.05). A general anesthetic became necessary in six patients (24%) with the lateral popliteal approach and none with the classic approach (P < 0.05). The onset of complete sensory and motor blockade was significantly faster in the classic group (12 +/- 6 min) as compared with the popliteal group (26 +/- 10 min; P < 0.05). Conclusion A double injection with a relatively low volume of 0.75% ropivacaine generated a higher success rate and a shorter onset time of sensory and motor blockade after the classic Labat approach than after a lateral popliteal approach.

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Infragluteal-Parabiceps Sciatic Nerve Block: An Evaluation of a Novel Approach Using a Single-Injection Technique

Anesthesia & Analgesia ◽

10.1213/01.ane.0000049822.11466.64 ◽

2003 ◽

pp. 868-873 ◽

Cited By ~ 29

Author(s):

Radha Sukhani ◽

Kenneth D. Candido ◽

Robert Doty ◽

Edward Yaghmour ◽

and Robert J. McCarthy

Keyword(s):

Sciatic Nerve ◽

Nerve Block ◽

Single Injection ◽

Sciatic Nerve Block ◽

Injection Technique ◽

Novel Approach

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Comparison of the Parasacral Approach and the Posterior Approach, with Single- and Double-Injection Techniques, to Block the Sciatic Nerve

Anesthesiology ◽

10.1097/00000542-200306000-00021 ◽

2003 ◽

Vol 98 (6) ◽

pp. 1436-1441 ◽

Cited By ~ 41

Author(s):

Philippe Cuvillon ◽

Jacques Ripart ◽

Pascal Jeannes ◽

Aba Mahamat ◽

Christophe Boisson ◽

...

Keyword(s):

Sciatic Nerve ◽

Nerve Block ◽

Single Injection ◽

Onset Time ◽

Sciatic Nerve Block ◽

Success Rates ◽

Posterior Superior Iliac Spine ◽

Similar Time ◽

Double Injection ◽

Injection Group

Background The purpose of this study was to compare parasacral and Winnie's single- or double-injection approaches for sciatic nerve block. Methods One hundred fifty adults scheduled to undergo lower limb surgery were randomized to receive on the sciatic nerve 20 ml ropivacaine, 0.75%: single bolus for parasacral and Winnie's single injection. For Winnie's double injection, the peroneal and tibial nerves received separately 10 ml plus 10 ml. Blocks were performed with the use of nerve stimulator (intensity < 0.5 mA, 1 Hz). For the parasacral method, a line was drawn between the posterior superior iliac spine and the ischial tuberosity; needle entry was at 6 cm inferior to the posterior superior iliac spine. Results The groups were similar. Time to perform the block was 2 (1-5) min for the parasacral method, with no difference from Winnie's single injection (3 [1-10] min), but was shorter with double injection (5.5 [2-15] min) (P = 0.0001). Onset of sensory block was similar in the parasacral (25 [7.5-50] min) and Winnie single-injection groups (25 [5-50] min) but significantly longer in the double-injection group (15 [5-50] min). Success rates for complete block were similar in the parasacral (66%) and Winnie's double-injection groups (68%) after 30 min but higher in the Winnie's single-injection group for tibial sensory and motor block (48%) (P < 0.017). Conclusion Time to perform a parasacral block was short, and the parasacral approach had a high success rate and a short onset time. Therefore, this block might be a useful alternative to Winnie's modification for sciatic nerve block.

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