Skip to main content
SpringerLink
Log in

A randomized comparison of long-axis and short-axis imaging for in-plane ultrasound-guided popliteal-sciatic perineural catheter insertion

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Ultrasound-guided long-axis in-plane sciatic perineural catheter insertion has been described but not validated. For the popliteal-sciatic nerve, we hypothesized that a long-axis in-plane technique, placing the catheter parallel and posterior to the nerve, results in faster onset of sensory anesthesia compared to a short-axis in-plane technique.

Methods

Preoperatively, patients receiving a popliteal-sciatic perineural catheter were randomly assigned to either the long-axis or short-axis technique. Mepivacaine 2 % was administered via the catheter following insertion. The primary outcome was time to achieve complete sensory anesthesia. Secondary outcomes included procedural time, onset time of motor block, and pain on postoperative day 1.

Results

Fifty patients were enrolled. In the long-axis group (n = 25), all patients except 1 (4 %) had successful catheter placement per protocol. Two patients (8 %) in the long-axis group and 1 patient (4 %) in the short-axis group (n = 25) did not achieve sensory anesthesia by 30 min and were withdrawn. Seventeen of 24 (71 %) and 17 of 22 (77 %) patients in the short-axis and long-axis groups, respectively, achieved the primary outcome of complete sensory anesthesia (p = 0.589). The short-axis group (n = 17) required a median (10th–90th ‰) of 18.0 (8.4–30.0) min compared to 18.0 (11.4–27.6) min for the long-axis group (n = 17, p = 0.208) to achieve complete sensory anesthesia. Procedural time was 6.5 (4.0–12.0) min for the short-axis and 9.5 (7.0–12.7) min for the long-axis (p < 0.001) group. There were no statistically significant differences in other secondary outcomes.

Conclusion

Long-axis in-plane popliteal-sciatic perineural catheter insertion requires more time to perform compared to a short-axis in-plane technique without demonstrating any advantages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Singelyn FJ, Aye F, Gouverneur JM. Continuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery. Anesth Analg. 1997;84:383–6.

    CAS  PubMed  Google Scholar 

  2. Ilfeld BM, Morey TE, Wang RD, Enneking FK. Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology. 2002;97:959–65.

    Article  CAS  PubMed  Google Scholar 

  3. White PF, Issioui T, Skrivanek GD, Early JS, Wakefield C. The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003;97:1303–9.

    Article  PubMed  Google Scholar 

  4. Singelyn FJ, Gouverneur JM, 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.

    CAS  PubMed  Google Scholar 

  5. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259–65.

    Article  PubMed  Google Scholar 

  6. Ilfeld BM, Fredrickson MJ, Mariano ER. Ultrasound-guided perineural catheter insertion: three approaches but few illuminating data. Reg Anesth Pain Med. 2010;35:123–6.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Lee DK, Maldonado RC, Ilfeld BM. Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med. 2009;34:480–5.

    Article  PubMed  Google Scholar 

  8. Mariano ER, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Afra R, Ball ST, Meyer RS, Maldonado RC, Ilfeld BM. Ultrasound guidance versus electrical stimulation for femoral perineural catheter insertion. J Ultrasound Med. 2009;28:1453–60.

    PubMed  Google Scholar 

  9. Mariano ER, Loland VJ, Sandhu NS, Bishop ML, Lee DK, Schwartz AK, Girard PJ, Ferguson EJ, Ilfeld BM. Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia. Can J Anaesth. 2010;57:919–26.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Wang AZ, Gu L, Zhou QH, Ni WZ, Jiang W. Ultrasound-guided continuous femoral nerve block for analgesia after total knee arthroplasty: catheter perpendicular to the nerve versus catheter parallel to the nerve. Reg Anesth Pain Med. 2010;35:127–31.

    Article  PubMed  Google Scholar 

  11. Tammam TF. Ultrasound-guided infragluteal sciatic nerve block: a comparison between four different techniques. Acta Anaesthesiol Scand. 2013;57:243–8.

    Article  CAS  PubMed  Google Scholar 

  12. Tammam TF. Ultrasound-guided sciatic nerve block: a comparison between four different infragluteal probe and needle alignment approaches. J Anesth. 2013. doi:10.1007/s00540-013-1753-y

  13. Mariano ER, Kim TE, Funck N, Walters T, Wagner MJ, Harrison TK, Giori N, Woolson S, Ganaway T, Howard SK. A randomized comparison of long-and short-axis imaging for in-plane ultrasound-guided femoral perineural catheter insertion. J Ultrasound Med. 2013;32:149–56.

    PubMed  Google Scholar 

  14. Sahin L, Gurkan Y. “Figure of four” position and long-axis sciatic nerve scan with ultrasound facilitates sciatic perineural catheter placement. Agri. 2010;22:175–7.

    PubMed  Google Scholar 

  15. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2002;89:254–9.

    Article  CAS  PubMed  Google Scholar 

  16. Buys MJ, Arndt CD, Vagh F, Hoard A, Gerstein N. Ultrasound-guided sciatic nerve block in the popliteal fossa using a lateral approach: onset time comparing separate tibial and common peroneal nerve injections versus injecting proximal to the bifurcation. Anesth Analg. 2010;110:635–7.

    Article  PubMed  Google Scholar 

  17. Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, L’Hermite J, Boisson C, Vialles N, Lefrant JY, de La Coussaye JE. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009;108:641–9.

  18. Prasad A, Perlas A, Ramlogan R, Brull R, Chan V. Ultrasound-guided popliteal block distal to sciatic nerve bifurcation shortens onset time: a prospective randomized double-blind study. Reg Anesth Pain Med. 2010;35:267–71.

    Article  PubMed  Google Scholar 

  19. Perlas A, Wong P, Abdallah F, Hazrati LN, Tse C, Chan V. Ultrasound-guided popliteal block through a common paraneural sheath versus conventional injection: a prospective, randomized, double-blind study. Reg Anesth Pain Med. 2013;38:218–25.

    Article  CAS  PubMed  Google Scholar 

  20. de Tran QH, Gonzalez AP, Bernucci F, Pham K, Finlayson RJ. A randomized comparison between bifurcation and prebifurcation subparaneural popliteal sciatic nerve blocks. Anesth Analg. 2013;116:1170–5.

    Article  Google Scholar 

  21. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012;37:410–4.

    Article  CAS  PubMed  Google Scholar 

  22. Ilfeld BM, Le LT, Ramjohn J, Loland VJ, Wadhwa AN, Gerancher JC, Renehan EM, Sessler DI, Shuster JJ, Theriaque DW, Mariano ER; PAINfRETM Investigators. The effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: a multicenter, randomized, observer-masked, controlled study. Anesth Analg. 2009;108:345–50.

  23. Ilfeld BM, Loland VJ, Gerancher JC, Wadhwa AN, Renehan EM, Sessler DI, Shuster JJ, Theriaque DW, Maldonado RC, Mariano ER. The effects of varying local anesthetic concentration and volume on continuous popliteal sciatic nerve blocks: a dual-center, randomized, controlled study. Anesth Analg. 2008;107:701–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Kan JM, Harrison TK, Kim TE, Howard SK, Kou A, Mariano ER. An in vitro study to evaluate the utility of the “air test” to infer perineural catheter tip location. J Ultrasound Med. 2013;32:529–33.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge the invaluable assistance of the entire operating and recovery room staff at the VA Palo Alto Health Care System, especially our Regional Anesthesia and Acute Pain Medicine Fellows, Drs. Jack Kan, Nate Ponstein, Brett Miller, Justin Workman, and Genie Kim.

Conflict of interest

Dr. Mariano has received unrestricted educational program funding paid to his institution from I-Flow Corporation (Lake Forest, CA, USA). This company had no input into any aspect of the present study design and implementation; data collection, analysis and interpretation; or manuscript preparation. Dr. Mariano has received research grant funding from the Foundation for Anesthesia Education and Research.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA

    T. Edward Kim, Steven K. Howard, Natasha Funck, T. Kyle Harrison, Tessa L. Walters, Michael J. Wagner, Toni Ganaway & Edward R. Mariano

  2. Podiatry Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Jonah Mullens & Bruce Lehnert

  3. Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (112A), Palo Alto, 94304, CA, USA

    T. Edward Kim, Steven K. Howard, Natasha Funck, T. Kyle Harrison, Tessa L. Walters, Michael J. Wagner, Toni Ganaway & Edward R. Mariano

Authors
  1. T. Edward Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven K. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natasha Funck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Kyle Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tessa L. Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toni Ganaway
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonah Mullens
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruce Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Edward R. Mariano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward R. Mariano.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Edward Kim, T., Howard, S.K., Funck, N. et al. A randomized comparison of long-axis and short-axis imaging for in-plane ultrasound-guided popliteal-sciatic perineural catheter insertion. J Anesth 28, 854–860 (2014). https://doi.org/10.1007/s00540-014-1832-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-014-1832-8

Keywords

Search

Navigation