Abstract
Purpose
This two part study was undertaken to assess both the feasibility of identifying the saphenous nerve with a nerve stimulator and to assess the efficacy of saphenous nerve anaesthesia with electrical isolation of the nerve.
Methods
(Part 1): In Pan I we studied 25 volunteers. Each had saphenous nerve blocks performed using a nerve stimulator (NS) and loss of resistance (LOR) technique. We recorded 10 cm linear visual analogue pain scores on completion of the blocks, time to completion of the blocks, onset time, and success of the blocks. (Part II): Clinical utility of the NS technique of saphenous nerve block was investigated. We evaluated the NS technique in 21 consecutive patients having surgery below the knee.
Results
(Part I): The LOR technique successfully produced saphenous nerve anaesthesia in 18/25 (72%) volunteers and the NS technique was successful in all volunteers (25/25 — P < 0.05). The nerve stimulator approach required more time to complete (NS 13 ± 7 min vs LOR 8 ± 2 min; P < 0.05). Visual analogue pain scores differed (P < 0.05) with a median of 1.0 cm for the LOR technique and a median of 2 cm for the NS technique. (Part II): The saphenous nerve block was successful in 20/21 (95%) of the patients.
Conclusions
(Part I): The first part of the study established the feasibility of electrical identification of the saphenous nerve and demonstrated that the NS technique could be utilized to provide superior anaesthesia of the saphenous nerve when compared with a previously validated LOR technique. (Part II): The clinical utility of the NS technique of saphenous nerve block was successfully demonstrated.
Résumé
Objectif
Cette étude en deux parties visait à évaluer s’il est possible d’identifier le nerf saphène avec un stimulateur électrique et si le bloc nerveux de ce nerf réalisé de cette façon est efficace.
Méthodes
(Première partie): Celle-ci incluait 25 volontaires qui ont tous subi des blocs du nerf saphène réalisés après identification avec une stimulateur nerveux (SN) et suivant la technique de la perte de résistance (PR). Ont été enregistrés après le bloc: les scores de douleur sur une échelle visuelle analogique, le temps requis pour compléter le bloc, le temps de latence, et le succès du bloc. (Deuxième partie): L’utilité, en clinique, du bloc du nerf saphène sous SN a été étudiée chez 21 patients subissant une intervention sous te genou.
Résultats
(Première partie): La technique PR a permis de réussir l’anesthésie du nerf saphène chez 18 des 25 volontaires (72%) alors que la technique SN a réussi chez tous les volontaires (25 sur 25; P < 0,05). L’approche avec stimulateur nerveux a été plus longue à réaliser (SN 13 ±7 min vs PR 8 ±2 min; P < 0,05). Les scores sur l’échelle visuelle étaient différents (P < 0,05) avec une médiane de 1.0 cm pour la technique PR et une médiane de 2 cm pour la technique SN. (Deuxième partie): Le bloc du nerf saphène a réussi chez 20 des 21 (95%) des patients.
Conclusions
(Première partie): La faisabilité de l’identification électrique du nerf saphène a été démontrée. La technique SN peut être utilisée pour procurer une meilleure anesthésie du nerf saphène que la technique PR déjà confirmée. (Deuxième partie): L’utilité clinique de la technique SN de bloc du nerf saphène a été démontrée.
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References
Kofoed H. Peripheral nerve blocks at the knee and ankle in operations for common foot disorders. Clin Orthop 1982; 168: 97–101.
Bridenbaugh PO. The lower extremity: somatic blockade.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 2nd ed. Philadelphia: J.B. Lippincott Co., 1988: 417–41.
van der Wal M, Lang SA, Yip RW. Transsartorial approach for saphenous nerve block. Can J Anaesth 1993; 40: 542–6.
Hunter LY, Louis DS, Ricciardi JR, O’Connor GA. The saphenous nerve: its course and importance in medial arthrotomy. Am J Sports Med 1979; 7: 227–30.
Chang PC, Lang SA, Yip RW. Reevaluation of the sciatic nerve block. Reg Anesth 1993; 18: 18–23.
Shannon J, Lang SA, Yip RW, Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator tech nique. Reg Anesth 1995; 20: 100–4.
McLeod DH, Wong DHW, Claridge RJ, Merrick PM. Lateral popliteal sciatic nerve block compared with subcu taneous infiltration for analgesia following foot surgery. Can J Anaesth 1994; 41: 673–6.
Romanoff ME, Cory PC, Kalenak A, Keyser GC, Marshall WK. Saphenous nerve entrapment at the adductor canal. Am J Sports Med 1989; 17: 478–81.
Defalque RJ, McDanal JT. Proximal saphenous neuralgia after coronary bypass. (Abstract) Reg Anesth 1994; 19: 90.
Hopkins PM, Ellis FR, Halsall PJ. Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve. Anaesthesia 1991; 46: 95–6.
Pither CE, Raj PP, Ford DJ. The use of peripheral nerve stimulators for regional anesthesia. A review of experi mental characteristics, technique, and clinical applications. Reg Anesth 1985; 10: 49–58.
Singelyn FJ, Gouverneur J-MA, Gribomont BF. Popliteal sciatic nerve block aided by a nerve stimulator: a reliable technique for foot and ankle surgery. Reg Anesth 1991; 16: 278–81.
Albert DB. Use of the nerve stimulator.In: Altman RA, Bernstein RL, Broadman LM, Marshall MH, Rosenberg AD (Eds.). Regional Blocks: How to do them. 67th Congress of the International Anesthesia Research Society, San Diego, Ca 1993.
Kaiser H, Niesel HC, Klimpel L, Bodenmueller M. Prilo caine in lumbosacral plexus block — general efficacy and comparison of nerve stimulation amplitude. Acta Anesthesiol Scand 1992; 36: 692–7.
Winnie AP. Does the transsartorial technique of axillary block provide a higher success rate and a lower complica tion rate than a paresthesia technique? New evidence and old (Editorial). Reg Anesth 1995; 20: 482–5.
Moore DC, Mulroy MF, Thompson GE. Peripheral nerve damage and regional anaesthesia (Editorial). Br J Anaesth 1994; 73: 435–6.
Podugu R, Morscher A, Smith CE, Patel N, Rinchak AC. Influence of anesthetic technique and agent on cost of ambulatory anesthesia. Anesthesiology 1995; 83: A49.
Ritchie ED, Chung F, Su J, Claxton A, Thanamayooran S. Indicators of excessive pain in ambulatory surgery. Anesthesiology 1995; 83: A46.
Tetzlaff JE, Yoon HJ, Brems J. Patient acceptance of inter scalene block for shoulder surgery. Reg Anesth 1993; 18: 30–3.
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Comfort, V.K., Lang, S.A. & Yip, R.W. Saphenous nerve anaesthesia — a nerve stimulator technique. Can J Anaesth 43, 852–857 (1996). https://doi.org/10.1007/BF03013038
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DOI: https://doi.org/10.1007/BF03013038