SLR - November 2014 - Ian M. Yarger

Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-Blind Study

Reference: Borglum, J, Johansen, K, Christensen, M. et al.  Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-blind Study.  Regional Anesthesia & Pain Medicine. 39(1):18-25, January/February 2014.

Scientific Literature Review

Reviewed By: Ian M. Yarger, DPM
Residency Program: North Colorado Podiatric Medicine and Surgery Residency, Greeley, CO

Podiatric Relevance: This article presents a new technique for regional block of the sciatic and saphenous nerves at the level of the thigh that may reduce procedure time when compared to traditional popliteal block with saphenous nerve augmentation. It was hypothesized that the single-penetration dual-injection (SPEDI) technique would reduce block performance time without affecting quality of post operative pain control.  

Methods: Sixty patients preparing for foot or lower leg surgery were randomized into two study groups. The first received a traditional popliteal/saphenous block under ultrasound guidance and the second group receiving a block using the SPEDI technique. Fifteen ml of ropivacaine 0.75 percent around the sciatic nerve and 5 ml of ropivacaine 0.75 percent at the saphenous. Positioning time, pain assessment, nausea in the post anesthesia care unit, sufentanil demand, dermatomal anesthesia, and degree of motor blockade were also recorded.

Results: The SPEDI technique significantly reduced block performance time (Median time 110 seconds vs. 246 seconds). Positioning patients to prepare for the SPEDI block was significantly shorter compared to positioning time for the traditional ultrasound guided popliteal/saphenous block. No significant difference was found between the two blocks when comparing pain assessment, nausea, sufentanil demand, dermatomal anesthesia, and motor blockade.

Conclusions: The SPEDI block was faster to perform, reduced positioning time, and was equally as effective when compared to the traditional popliteal/saphenous block. Using the SPEDI block in place of a traditional popliteal block has the potential to save time without compromising the quality of the block therefore reducing overall time and potentially cost of procedure.   

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