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Electrical Stimulation Versus Ultrasound Guidance for Popliteal-Sciatic Perineural Catheter Insertion: A Randomized Controlled Trial
  1. Edward R. Mariano, MD, MAS*,
  2. Gloria S. Cheng, MD*,
  3. Lynna P. Choy, MD*,
  4. Vanessa J. Loland, MD*,
  5. Richard H. Bellars, MD*,
  6. NavParkash S. Sandhu, MD*,
  7. Michael L. Bishop, MD*,
  8. Daniel K. Lee, DPM, FACFAS,
  9. Rosalita C. Maldonado, BS* and
  10. Brian M. Ilfeld, MD, MS*
  1. From the Departments of *Anesthesiology and
  2. Orthopedic Surgery, University of California, San Diego Medical Center, San Diego, CA.
  1. Address correspondence to: Brian M. Ilfeld, MD, MS, Department of Anesthesiology, University of California, San Diego, Center for Pain Medicine, 9300 Campus Point Dr, MC 7651, La Jolla, CA 92037-7651 (e-mail: bilfeld{at}


Background: Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES.

Methods: Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot and/or ankle surgery were randomly assigned to either the ES with a stimulating catheter or US-guided technique with a nonstimulating catheter. The primary end point was catheter insertion duration (in minutes) starting when the US transducer (US group) or catheter-placement needle (ES group) first touched the patient and ending when the catheter-placement needle was removed after catheter insertion.

Results: All US-guided catheters were placed per protocol (n = 20), whereas only 80% of stimulation-guided catheters could be placed per protocol (n = 20, P = 0.106). All catheters placed per protocol in both groups resulted in a successful surgical block. Perineural catheters placed by US took a median (10th-90th percentile) of 5.0 min (3.9-11.1 min) compared with 10.0 min (2.0-15.0 min) for stimulation (P = 0.034). Subjects in the US group experienced less pain during catheter placement, scoring discomfort a median of 0 (0.0-2.1) compared with 2.0 (0.0-5.0) for the stimulation group (P = 0.005) on a numeric rating scale of 0 to 10.

Conclusions: Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.

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  • Reprints will not be available from the authors.

  • Funding for this project was provided by National Institutes of Health grant GM077026 (principal investigator: Dr. Ilfeld) from the National Institute of General Medical Sciences (Bethesda, Md) and the Department of Anesthesiology, University of California, San Diego Medical Center (San Diego, Calif).