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Effects of the Intraneural and Subparaneural Ultrasound-Guided Popliteal Sciatic Nerve Block: A Prospective, Randomized, Double-Blind Clinical and Electrophysiological Comparison
  1. Gianluca Cappelleri, MD*,
  2. Valeria Libera Eva Cedrati, MD*,
  3. Luisa Luciana Fedele, MD,
  4. Marco Gemma, MD,
  5. Laura Camici, MD,
  6. Mario Loiero, MD*,
  7. Mauro Battista Gallazzi, MD* and
  8. Gabriele Cornaggia, MD*
  1. From the *Istituto Ortopedico G. Pini; †Università dell'Insubria di Varese; and ‡IRCCS San Raffaele, Milan, Italy
  1. Address correspondence to: Gianluca Cappelleri, MD, Istituto Ortopedico G. Pini, Milan, via Caduti di Nassiriya 2, 20068 Peschiera Borromeo, Milan, Italy (e-mail: gianluca.cappelleri{at}gpini.it).

Abstract

Background and Objectives This prospective, randomized, double-blind study compared the effects of the ultrasound-guided popliteal sciatic nerve block performed by either intraneural or subparaneural approach followed by an electrophysiological evaluation. We hypothesized that intraneural injection provides a faster onset with a better success rate compared with the subparaneural approach.

Methods Eighty-eight patients were enrolled and randomized to receive an ultrasound-guided popliteal sciatic nerve block injecting 15 mL ropivacaine 1% according to an intraneural injection (group INTRA = 44) or a subparaneural injection (group SUBPARA = 44). The primary end point was the onset time of sensory and motor block, whereas secondary end points were successful, duration of the block, and the variation of the electrophysiological assessment after 5 weeks. The study was registered prior to patient enrollment (clinicaltrials.gov identifier NCT01987128).

Results The median onset time for successful sciatic nerve block in the INTRA group was 10 (5–15 [5–30]) minutes versus 25 (15–35 [5–45]) minutes in the SUBPARA group (P < 0.001), with a rate of 41/43 (95.3%) compared with 25/40 (62.5%) in the SUBPARA group (P < 0.001). No difference was found regardless of the duration of the block. Fifty-three patients also performed the electrophysiological assessment at 5 weeks, showing a subclinical, significant reduction in amplitude of the action potentials with no difference between groups. No patients reported any clinical neurological complications after 6 months.

Conclusions In ultrasound-guided popliteal sciatic nerve block, intraneural injection provided a faster onset and better success rate compared with subparaneural. Both techniques resulted in a similar subclinical reduction in amplitude of the sciatic action potentials at 5 weeks after surgery. These findings should not be extended to other approaches.

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Footnotes

  • The authors declare no conflict of interest.

    This study has been approved by the institutional review board Comitato Etico, IRCCS Policlinico via della Commenda 9, 20122 Milano, Italy (e-mail: comitato.etico{at}gpini.it).

    Clinical Trial Registry: Identifier NCT01987128, clinicaltrial.gov.

    Author contributions: G.C. helped design the study, conduct the study, and write the manuscript. V.L.E.C. helped design the study and write the manuscript. L.L.F. and M.L. helped design the study and conduct the study. M.G. helped analyze the data and write the manuscript. L.C. helped design the study. M.B.C. and G.C. helped conduct the study.

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org).

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