Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion a randomized controlled trial

Edward R. Mariano, Gloria S. Cheng, Lynna P. Choy, Vanessa J. Loland, Richard H. Bellars, Navparkash S. Sandhu, Michael L. Bishop, Daniel K. Lee, Rosalita C. Maldonado, Brian M. Ilfeld

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

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) com

Original languageEnglish (US)
Pages (from-to)480-485
Number of pages6
JournalRegional anesthesia and pain medicine
Volume34
Issue number5
DOIs
StatePublished - Sep 2009

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Mariano, E. R., Cheng, G. S., Choy, L. P., Loland, V. J., Bellars, R. H., Sandhu, N. S., Bishop, M. L., Lee, D. K., Maldonado, R. C., & Ilfeld, B. M. (2009). Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion a randomized controlled trial. Regional anesthesia and pain medicine, 34(5), 480-485. https://doi.org/10.1097/AAP.0b013e3181ada57a