Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial.

BACKGROUND:The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS:Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS:During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS:Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades

Lower extremity near-infrared spectroscopy after popliteal block for orthopaedic foot surgery

BACKGROUND: Noninvasive measurement of cutaneous tissue oxygenation using near-infrared spectroscopy (NIRS) has become common in peri-operative care. Following institution of peripheral nerve blocks, neurovascular alterations in the blocked region have been described. OBJECTIVE: The primary aim of this study encompassed the assessment of the influence of a popliteal block on changes in regional oxygen saturation (SrO(2)), and the location of most prominent changes. METHOD: We conducted a prospective randomised controlled trial. Hundred twenty patients who received a popliteal block for foot surgery were included. Popliteal block was performed under echographic guidance. The patients were randomized in 3 groups according to the location of the SrO(2) electrodes on the legs. Bilateral SrO(2) measurements were performed simultaneously. SrO(2) in the operated leg and in the control leg was measured at baseline and 1, 5, 10, 15, and 30 minutes after the perineural injection. We quantified the evolution in SrO(2) by calculating over time the differences in SrO(2) values between the operated and control leg (=ΔSrO(2)). RESULTS: At 30 minutes, ΔSrO(2) increased significantly (p<0.05) at the plantar side of the foot (11.3% ± 2.9%), above the ankle (4.9% ± 1.3%) and the popliteal fossa (3.6% ± 1.2%). CONCLUSION: At 30 minutes after institution of the popliteal block, ΔSrO(2) was most prominent at the plantar side of the foot as compared with measurement performed above the ankle or under the knee

Is resistance to ischaemia of motor axons in diabetic subjects due to membrane depolarization?

The reasons for the resistance to ischaemia of peripheral nerves in diabetics are not well understood. We have now explored whether axonal depolarization underlies this phenomenon, as has previously been proposed. Resistance to ischaemia was determined by the new method of “threshold tracking”. This method revealed an increase in excitability of the peroneal nerve at the popliteal fossa during ischaemia, and a decrease in excitability in the post-ischaemic period. The extent of these alterations in 28 type 1 diabetics without peripheral neuropathy showed a strong correlation with the mean blood glucose concentrations during the last 24 h before examination. To test whether the ischaemic resistance was related to membrane potential, we also measured axonal superexcitability in 11 selected diabetics, since it has been shown that post-spike changes in excitability depend on membrane potential. Changes in excitability of the peroneal nerve were measured in the period between 10 and 30 msec following a conditioning supramaximal compound action potential. Under resting conditions, no differences in the post-spike superexcitability were found between controls and diabetics, despite striking differences in their responses to a 10-min pressure cuff. These observations indicate that membrane depolarization is not involved in the resistance to ischaemia of motor axons in diabetic subjects

Sciatic neuropathy with preserved sensory nerve action potentials, a case series

Background: Sciatic neuropathy is differentiated from lumbosacral radiculopathy based on the finding of abnormal sensory nerve action potentials (SNAPs). Cases of sciatic neuropathy with intact SNAPS have not been well described. Methods: A retrospective analysis of 12 patients with sciatic neuropathy in a single institution. Results: We describe 12 patients in whom a sciatic neuropathy was diagnosed based on a combination of history, physical exam, radiological and electrodiagnostic (EDX) findings. Lower extremity SNAPs were found to be within normal range in all patients, although SNAP amplitude asymmetry between both sides was observed in 3. Included patients were young (mean age of 40.3 years) and mostly female (9 patients). Conclusions: Sciatic neuropathy may occur with a relative sparing of sensory fibers. Recognition of this group of patients should help to avoid making a misdiagnosis of lumbosacral radiculopathy

Clathrin structure characterized with monoclonal antibodies. I. Analysis of multiple antigenic sites.

Three monoclonal antibodies that react with previously undefined antigenic determinants on the clathrin molecule have been produced and characterized. They were isolated from a fusion between myeloma cells and popliteal lymphocytes from SJL mice that had received footpad injections of human brain clathrin. This protocol was chosen to favor the production of antibodies to poorly immunogenic proteins and thereby increase the repertoire of anti-clathrin monoclonal antibodies. One antibody (X16) reacts preferentially with the heavier of the two clathrin light chains (LCa) when it is not associated with heavy chain. This specificity is different from that of the anti-LCa antibody, CVC.6, which has preferential reactivity with heavy chain-associated LCa. In addition, X16 and CVC.6 bound simultaneously to LCa, confirming that they react with different sites. The other two antibodies produced, X19 and X22, react with two different determinants on the clathrin heavy chain, based on immunoprecipitation, Western blot, and binding studies. Competitive binding studies with anti-clathrin monoclonal antibodies showed that they define a total of five distinct antigenic determinants on bovine clathrin

Additional femoral catheter in combination with popliteal catheter for analgesia after major ankle surgery

Background The contribution of the saphenous nerve in pain after major ankle surgery is unknown. The aim of this study was to evaluate its contribution in this context. Methods Fifty patients were included in this prospective, randomized, controlled study. In all patients [Group P (popliteal) and Group F (popliteal+femoral)], a popliteal catheter was placed before operation and ropivacaine 0.5% (30 ml) administered via this catheter; major ankle surgery was then performed under spinal anaesthesia. In Group PF patients, an additional femoral catheter was sited before operation and ropivacaine 0.5% (10 ml) administered. Six hours after spinal anaesthesia (defined as T0), a continuous infusion of ropivacaine 0.3% (14 ml h−1) was started through the popliteal catheter until T24. Then, the concentration was reduced to 0.2% until T48. Patients in Group PF received continuous ropivacaine 0.2% (5 ml h−1) through the femoral catheter from T0 to T48. I.V. morphine patient-controlled analgesia was used as a rescue analgesia. Pain at rest, pain with movement, adverse effects, and i.v. morphine consumption were assessed. Pain at rest and on movement was evaluated 6 months after operation. Results Pain at rest was comparable in the two groups. In Group PF, patients had significantly reduced pain during movement in the postoperative period (P=0.01) and 6 months after operation (P=0.03). Morphine consumption was significantly reduced in Group PF at T0-T24 and T24-T48 (P=0.01). Adverse effects were comparable in both groups. Conclusions The addition of continuous femoral catheter infusion of ropivacaine to a continuous popliteal catheter infusion improved postoperative analgesia during movement after major ankle surgery. This effect was still present 6 months after surger

The acute effects of two different self-myofascial release products on the calf muscle pump and plantar flexion ankle range of motion

textBackground: Massage can promote healing and recovery following exercise. (Carefelli et al. 1992). Barnes (1990) proposed that myofascial release helps to break up fibrotic fascial adhesions that may restrict joint range of motion (ROM). Self-myofascial release (SMR) is a type of massage that uses a roller and an individuals body weight to produce massage like loading over a specific anatomical area. Viscoelastic properties of muscle tissue extensibility increase during an acute bout (15 minutes) of massage-like loading (Haas et al 2012). Self-massage on the calves reduced pain and edema of the calves on nurses after an 8.5-hour work shift (Oh and Yoon 2008). Increasing blood flow through skeletal muscle will lead to increased oxygen delivery, which can increase healing and return to homeostasis post-exercise. Different shapes and densities of SMR rollers may produce different outcomes (Johansson 1962, Curran et al. 2012). Hypothesis: TP Footballer will have a greater effect on popliteal artery blood flow volume and ankle ROM vs. the SPRI® foam roller. Methods: N = 21 subjects (10 male 11 female; 18-27). No current lower extremity injury (within one year). No exercise 48 hours prior to data collection. Exercise was defined as any rigorous physical activity lasting 30 minutes or longer. Subjects rested prone 20 minutes. Resting BF and AD measurements were taken with an 8-13 MHz probe via Sonosite Micromaxx Doppler Ultrasound. Ankle ROM taken with a goniometer (mean of 3x). Statistics: Two-way repeated measure ANOVA and Bonferroni test was used to compare pre-test and post-test measures across both treatment conditions with two types of rollers. The α level was set at 0.05. Results: No significant increases found using the SPRI® foam roller on variables of BF Volume, TAP and ROM in plantar flexion. Significant increases found with arterial diameter. Significant increases using the TP Therapy Products Footballer® on variables of: ROM in plantar flexion, blood flow volume, arterial diameter Conclusion: SPRI® foam roller and TP Footballer® significantly increased popliteal arterial diameter. The TP Therapy Products Footballer® increased blood flow volume immediately following TP Therapy Soleus Protocol. TP Therapy Products Footballer® increased ankle plantar flexion immediately following TP Therapy Soleus Protocol.Kinesiology and Health Educatio

Estudio comparativo del bloqueo anestésico del nervio ciático con ropivacaína 0,5% por vía medio-femoral versus poplítea lateral

Introducción: El bloqueo anestésico/analgésico del nervio ciático por vía medio-femoral es una técnica nueva que se ha utilizado para la analgesia postoperatoria de la cirugía de rodilla. Su mayor ventaja es que se puede realizar en decúbito supino, evitando el decúbito prono necesario en otras técnicas de abordaje, y que obliga al paciente a soportar dolor durante su realización. Objetivo: El objetivo de este estudio fue comparar la eficacia, tiempo de latencia y grado de aceptación del paciente entre el bloqueo anestésico/analgésico del nervio ciático realizado por vía medio-femoral y el bloqueo ciático lateral a nivel poplíteo en pacientes sometidos a cirugía de la extremidad inferior. Métodos: En este estudio de tipo aleatorio y prospectivo, se incluyeron 63 pacientes que iban a ser intervenidos quirúrgicamente de la extremidad inferior. En el grupo PB 32 pacientes recibieron un bloqueo ciático lateral a nivel poplíteo, mientras que en el grupo MF 31 pacientes recibieron el mismo bloqueo pero a nivel medio-femoral lateral. En ambos grupos la dosis de anestésico local administrada fue de 30 mi de ropivacaína al 0,5%. Resultados: La calidad del bloqueo fue similar en ambos grupos. Los tiempos de latencia del bloqueo (desde el final del bloqueo al inicio de su efecto) tanto sensitivo como motor fueron significativamente menores en el grupo MF que en el grupo PB (tabla 2). Sin embargo no hubo diferencia estadística en la duración del bloqueo sensitivo y motor entre ambos grupos. NO hubo tampoco diferencia en la dificultad de realización del bloqueo entre ellos. El grado de molestia para el paciente durante la inserción de la aguja de bloqueo fue similar. La tolerancia al manguito de isquemia fue mejor en el grupo MF, pero sin llegar a niveles de significación estadística. Medicina Balear 2004; 18-25 Conclusión: El abordaje medio-femoral del nervio ciático para cirugía de tobillo y pie, proporciona una anestesia eficaz comparable al abordaje poplíteo lateral. Esta nueva técnica es simple y segura, y proporciona una analgesia postoperatoria tan efectiva como la obtenida con el abordaje poplíteo lateral

Cравнение эффективности блокады седалищного нерва, выполняемой под уз-контролем тремя доступами: чрезъягодичным, подъягодичным и подколенным

АНЕСТЕЗИЯСЕДАЛИЩНЫЙ НЕРВПЕРИФЕРИЧЕСКАЯ БЛОКАДАСЕНСОРНЫЙ БЛОКМОТОРНЫЙ БЛОКУЗ-КОНТРОЛЬПОДЪЯГОДИЧНЫЙ ДОСТУППОДКОЛЕННЫЙ ДОСТУПЧРЕЗЪЯГОДИЧНЫЙ ДОСТУППОСЛЕОПЕРАЦИОННЫЙ ПЕРИО