scholarly journals A randomized controlled study of anterior lumbar plexus combined with parasacral sciatic nerve block under the guidance of ultrasound and nerve stimulator in elderly patients undergoing hip arthroplasty

2021 ◽  
Author(s):  
Wei Wu ◽  
Wen-hao Bu ◽  
Hai-bin Huang ◽  
Ying Mao ◽  
Yong-xing Tan
Keyword(s):  
Sciatic Nerve ◽  
Elderly Patients ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Skin Incision ◽  
Sciatic Nerve Block ◽  
Lumbar Plexus ◽  
Group A ◽  
Group B ◽  
First Time

Abstract Objectives: To explore the clinical application of anterior lumbar plexus combined with parasacral nerve block under the dual guidance of ultrasound and nerve stimulator in elderly hip arthroplasty.Methods: Forty elderly patients aged from 65 to 85 years old who underwent unilateral hip arthroplasty (Except for revision of hip joint) were randomly divided into two groups (n=20 in each group): ultrasound-guided anterior lumbar plexus combined with parasacral sciatic nerve block group (group A) and ultrasound-guided anterior lumbar plexus block group (group B). Both groups were assisted with sedation with different doses of dexmetopyrimidine and analgesia with different doses of sufentanil. Because the orthopaedic team of our hospital performed hip arthroplasty with mature technique and fixed operation time, the onset time of block in group An and B, heart rate and blood pressure at admission (T0), skin incision (T1), half hour after skin incision (T2) and skin suture(T3), intraoperative dosage ofdexmedetomidine and sufentanil, postoperative 1, 4, 8, 16, 24hVAS score and the first time of getting out of bed were recorded.Results: the heart rate and blood pressure at T1, T2 and T3 in group A were significantly lower than those in group B (P < 0.05). The amount of sufentanil used during operation in group), A was significantly lower than that in group B (P < 0.05). The postoperative scores of 1,4,8,16 and 24hVAS in group), A were significantly lower than those in group B (P < 0.05), and the time of getting out of bed for the first time after operation was shorter than that in group B (P < 0.05).Conclusion: compared with simple anterior lumbar plexus block, anterior lumbar plexus combined with parasacral sciatic nerve block in elderly patients with hip arthroplasty can make the intraoperative circulation more stable, the intraoperative dosage of opioids significantly reduced and the effect of early postoperative analgesia is better. it can also shorten the time for patients to get out of bed for the first time.

scholarly journals A randomized controlled study of anterior lumbar plexus combined with parasacral sciatic nerve block under the guidance of ultrasound and nerve stimulator in elderly patients undergoing hip arthroplasty

2021 ◽  
Author(s):  
wei wu ◽  
Wenhao Bu ◽  
Haibin Huang ◽  
Ying Mao ◽  
Yongxing Tan
Keyword(s):  
Sciatic Nerve ◽  
Elderly Patients ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Skin Incision ◽  
Sciatic Nerve Block ◽  
Lumbar Plexus ◽  
Group A ◽  
Group B ◽  
First Time

Abstract Objectives To explore the clinical application of anterior lumbar plexus combined with parasacral nerve block under the dual guidance of ultrasound and nerve stimulator in elderly hip arthroplasty. Methods Methods:Forty elderly patients aged from 65 to 85 years old who underwent unilateral hip arthroplasty (Except for revision of hip joint) were randomly divided into two groups (n = 20 in each group): ultrasound-guided anterior lumbar plexus combined with parasacral sciatic nerve block group (group A) and ultrasound-guided anterior lumbar plexus block group (group B). Both groups were assisted with sedation with different doses of dexmetopyrimidine and analgesia with different doses of sufentanil. Because the orthopaedic team of our hospital performed hip arthroplasty with mature technique and fixed operation time, the onset time of block in group An and B, heart rate and blood pressure at admission (T0), skin incision (T1), half hour after skin incision (T2) and skin suture(T3), intraoperative dosage ofdexmedetomidine and sufentanil, postoperative 1, 4, 8, 16, 24hVAS score and the first time of getting out of bed were recorded. Results the heart rate and blood pressure at T1, T2 and T3 in group A were significantly lower than those in group B (P < 0.05). The amount of sufentanil used during operation in group), A was significantly lower than that in group B (P < 0.05). The postoperative scores of 1,4,8,16 and 24hVAS in group), A were significantly lower than those in group B (P < 0.05), and the time of getting out of bed for the first time after operation was shorter than that in group B (P < 0.05). Conclusion compared with simple anterior lumbar plexus block, anterior lumbar plexus combined with parasacral sciatic nerve block in elderly patients with hip arthroplasty can make the intraoperative circulation more stable, the intraoperative dosage of opioids significantly reduced and the effect of early postoperative analgesia is better. it can also shorten the time for patients to get out of bed for the first time.

Comparing approaches to sciatic nerve blocks in dogs during tibial plateau-levelling osteotomy

2020 ◽  
Vol 25 (10) ◽  
pp. 1-7
Author(s):  
Robyn Thomson ◽  
Delphine Le Chevallier ◽  
Emma Love ◽  
Jo Murrell
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Lateral Approach ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Transgluteal Approach ◽  
Block Number ◽  
Group A ◽  
Group B ◽  
Approach Group

The aim of this study was to compare the postoperative analgesic requirements in dogs receiving a sciatic nerve block by either the lateral or transgluteal approach. The secondary aim was to determine if there was a difference in ease of performing the nerve block. Forty-two client-owned dogs were used in this study. Sciatic nerve block was performed by the transgluteal approach (group A), or the lateral approach (group B) combined with a psoas compartment block. All blocks were performed using a nerve stimulator and 0.1 ml/kg bupivacaine 0.5%, per block. The time taken to perform the sciatic nerve block, number of attempts, the current (mA), and intraoperative and postoperative opioid requirements were recorded. Overall, 52% of dogs required methadone intraoperatively, with no difference between groups (P=0.516). Postoperatively, 24% in group A and 12% in group B required methadone (P=0.314). There was no difference in the time taken to perform the sciatic nerve block, current or the number of attempts between groups. Both approaches to the sciatic nerve block conferred similar levels of analgesia and may be used as part of a multimodal analgesic protocol for dogs undergoing pelvic limb surgery.

scholarly journals SURGERIES OF LOWER LIMB UNDER COMBINED FEMORAL AND SCIATIC NERVE BLOCK

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Dr. Pawan Kumar Agrawal ◽  
Dr. Anil Kumar Gupta
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Lower Limb ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Total Duration ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Group A ◽  
Group B

INTRODUCTION:  Peripheral nerve blocks (PNB) can provide surgical anesthesia with better cardiorespiratory stability and is the best option for life-saving procedures  where both general and central neuraxialanesthesia are risky, and no fasting, , or preoperative optimization is required. One of the most useful anesthetic technique is the combination of sciatic and femoral nerve block (3:1) for lower limb surgery. Peripheral nerve blocks are generally suitable for lower limb surgeries because of the peripheral location and the potential to block pain pathways at multiple levels. Also PNBs avoid hemodynamic instability and, facilitate postoperative pain management, and assure a timely discharge of the patient. MATERIAL AND METHODS: In this prospective observational study 50 patients of 22 to 67 years age group of both sexes were included who were posted for lower limb surgeries. Patients were randomly divided into two groups of 25 each. In Group A: 20 ml of 0.5% ropivacaine for femoral nerve block and 20 ml of 0.5% ropivacaine for sciatic nerve block was given to the patients. In group B: 20 ml of 0.5% ropivacaine plus 25 µg fentanyl for femoral nerve block and 20 ml of 0.5% ropivacaine plus fentanyl 25 µg for sciatic nerve block was given. Visual analog scale (VAS) with 0 – 10 cm line was used to see the level of anesthesia in the postoperative period and interpreted as “0” means “no pain” and mark “10” means “severe pain.” Pain score was assessed every 30 min during surgery. If pain is experienced during surgery injection ketamine 0.5 mg/kg intravenously. RESULTS: This study was carried out on 50 patients divided into two groups of 25 each of age group of 22 to 67 years posted for lower limb surgeries. In group A mean age of the patients was 43.78± 12.47and in group B it was 42.33± 13.29. Out of total 25 patients operated in group A 21 (84%) were male and 4 (16%) female, while in group B male and female were 22 (88%) and 3 (12%) respectively. Mean onset of sensory block (Minutes) in group A and Group B was 11.94 ± 3.54 and 12.19 ± 2.67 respectively. Mean onset of motor block in group A was 17.59 ±3.47 minutes and in group B was17.87± 2.78 minutes. Total duration of sensory block in group A was 13.96 ± 0.27 hours and in group B 13.05 ± 0.98 hours. Total duration of motor block in group A was11.58 ± 1.56 hours and in group B12.88 ± 0.96 hours. VAS score was 0 till 8 hours of the study period then it started increasing in both the groups. Patients demanded the first dose of rescue analgesia at 16th hour.  CONCLUSION: Combined femoral-sciatic nerve block is one of the most useful anesthetic procedures and can be used without any major complications, it can also be used in critically ill patients.

scholarly journals Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Shoji Nishio ◽  
Shigeo Fukunishi ◽  
Tomokazu Fukui ◽  
Yuki Fujihara ◽  
Shohei Okahisa ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Total Hip Arthroplasty ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Sciatic Nerve Block ◽  
Nerve Blockade ◽  
Continuous Femoral Nerve Block

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

scholarly journals Efficacy of perineural versus systemic dexamethasone in prolonging analgesia after ultrasound guided femoral and sciatic nerve block for patients undergoing below knee surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Abdelaziz ◽  
H M Elzahaby ◽  
A A Elshebeiny ◽  
D M Heiba
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Onset Time ◽  
Analgesic Efficacy ◽  
Sensory Block ◽  
Postoperative Pain Management ◽  
Sciatic Nerve Block ◽  
Dexamethasone Group ◽  
Significant Difference ◽  
Group B

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective to compare the analgesic efficacy of both, intravenous and perineural administration of dexamethasone during femoral and sciatic nerve block using bupivacaine in patients undergoing below knee surgeries. Patients and Methods In our study, 50 patients were randomly divided into two equal groups: Group A (Perineural Dexamethasone group) [n = 25]: Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous. Group B (Systemic Dexamethasone group) [n = 25]: Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block. Results Our study showed that onset time for sensory block was (25.39 ± 3.79) mins for systemic group and (18.85 ± 4.11) mins in perineural group with a significant statistical difference (P &lt; 0.001) between both groups as the onset of sensory block in perineural group was significantly shorter than the systemic group and the duration of sensory block was (650.00 ± 62.8) mins in systemic group and (718.52 ± 62.06) mins in perineural group. The duration of sensory block was significantly shorter in systemic group than in perineural group with statistically high significant difference between groups (P &lt; 0.001). Onset time for motor block was (30.61 ± 4.89) mins in systemic group and (27.59 ± 3.31) mins in perineural group. Perineural group had shorter time of onset than systemic dexamethasone group with a significant difference between groups (P = 0.013). The duration of analgesia was significantly longer in perineural group than systemic group (P &lt; 0.001) Conclusion Dexamethasone was seen to be a potent adjunct to local anesthetic to prolong post operative analgesia with negligible side effects & better outcome to the perineural route.

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