José R Soberón1, Carrie McInnis2, Kim S Bland2, Allison L Egger3, Matthew E Patterson4, Clint E Elliott4, Robert J Treuting5, Kristie Osteen4. 1. Department of Anesthesiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA, 70121, USA. jsoberon@ochsner.org. 2. Department of Anesthesiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA, 70121, USA. 3. The Johns Hopkins Hospital, Baltimore, MD, USA. 4. Ochsner Clinic Foundation, Department of Anesthesiology, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA. 5. Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
Abstract
PURPOSE: Limited research data exist regarding optimal block techniques in the severely and morbidly obese patient population. We compared two approaches to sciatic nerve blockade at the popliteal fossa in severely and morbidly obese patients. The purpose of this study was to identify differences in pain scores, block onset characteristics, and adverse events between the proximal (prebifurcation) and the distal (postbifurcation) sites. METHODS:Patients with a body mass index ≥35 scheduled for unilateral foot surgery with a popliteal block were randomized to receive an ultrasound-guided popliteal block proximal or distal to the bifurcation of the sciatic nerve. The primary endpoint was numerical rating scale (NRS) scores in the post anesthesia care unit (PACU). RESULTS:Thirty patients were enrolled in each group for a total of 60 participants. Patients in the distal group had lower NRS scores upon entry into the PACU (0.70 ± 1.91) compared with the proximal group (2.17 ± 3.37), had a faster onset of sensorimotor blockade, and were less likely to require a repeat block procedure, conversion to general anesthesia, or local anesthetic supplementation by the surgical team. There was no difference in block procedure times or incidence of nerve injury between the two groups. CONCLUSIONS: The distal approach to the popliteal block provided several intraoperative and analgesic benefits without a difference in block procedural times in the severely and morbidly obese. It is a cost-free intervention that results in a higher likelihood of a successful block in a population where avoidance of opioids is desirable.
RCT Entities:
PURPOSE: Limited research data exist regarding optimal block techniques in the severely and morbidly obesepatient population. We compared two approaches to sciatic nerve blockade at the popliteal fossa in severely and morbidly obesepatients. The purpose of this study was to identify differences in pain scores, block onset characteristics, and adverse events between the proximal (prebifurcation) and the distal (postbifurcation) sites. METHODS:Patients with a body mass index ≥35 scheduled for unilateral foot surgery with a popliteal block were randomized to receive an ultrasound-guided popliteal block proximal or distal to the bifurcation of the sciatic nerve. The primary endpoint was numerical rating scale (NRS) scores in the post anesthesia care unit (PACU). RESULTS: Thirty patients were enrolled in each group for a total of 60 participants. Patients in the distal group had lower NRS scores upon entry into the PACU (0.70 ± 1.91) compared with the proximal group (2.17 ± 3.37), had a faster onset of sensorimotor blockade, and were less likely to require a repeat block procedure, conversion to general anesthesia, or local anesthetic supplementation by the surgical team. There was no difference in block procedure times or incidence of nerve injury between the two groups. CONCLUSIONS: The distal approach to the popliteal block provided several intraoperative and analgesic benefits without a difference in block procedural times in the severely and morbidly obese. It is a cost-free intervention that results in a higher likelihood of a successful block in a population where avoidance of opioids is desirable.
Authors: Karen C Nielsen; Ulrich Guller; Susan M Steele; Stephen M Klein; Roy A Greengrass; Ricardo Pietrobon Journal: Anesthesiology Date: 2005-01 Impact factor: 7.892
Authors: R M Herman; J B Brower; D G Stoddard; A R Casano; J H Targovnik; J H Herman; P Tearse Journal: Int J Obes (Lond) Date: 2006-06-13 Impact factor: 5.095