Search PubMed⌕ Search

Biomedical subjects

Peter G Atanassoff

Publications and source records attributed to Peter G Atanassoff.

18 recordsLinked to original sources
PubMed2006

What is the minimum effective volume of local anesthetic required for sciatic nerve blockade? A prospective, randomized comparison between a popliteal and a subgluteal approach.

For sciatic nerve blockade, no study has defined the optimal volume of local anesthetic required to block the nerve. The current, prospective, randomized investigation was designed to find a minimum volume of 1.5% mepivacaine required to block the sciatic nerve using the subgluteal and posterior popliteal approaches. A total of 56 patients undergoing foot surgery were randomly assigned to receive sciatic nerve block by means of a posterior subgluteal (group subgluteal, n = 28) or a posterior popliteal (group popliteal, n = 28) approaches. All blocks were performed with the use a nerve stimulator (stimulating frequency, 2 Hz, intensity 1.5-0.5 mA) and a perineural stimulating catheter. In all patients, plantar flexion of the foot was elicited at <0.5 mA, to maintain consistency among groups. The volume of local anesthetic used in each patient was based on the modified Dixon's up-and-down method. Complete anesthesia was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot 20 min after injection. The mean volume of local anesthetic required to block the sciatic nerve was 12 +/- 3 mL in the subgluteal group and 20 +/- 3 mL in the popliteal group (P < 0.05). The ED95 for adequate block of the sciatic nerve was 17 mL in the subgluteal group and 30 mL in the popliteal group. The authors conclude that a larger volume of local anesthetic is necessary to block the sciatic nerve at a more distal site (popliteal approach) as compared with a more proximal level (subgluteal approach).

Anesthetics, Local↗
PubMed2006

A prospective, randomized comparison between the popliteal and subgluteal approaches for continuous sciatic nerve block with stimulating catheters.

In this prospective, blinded study, we randomized 56 patients undergoing hallux valgus repair to receive continuous sciatic nerve block using a subgluteal (n = 28) or a posterior popliteal approach (n = 28) with a perineural stimulating catheter. Postoperatively, the stimulating catheter was connected to a patient-controlled analgesia pump with 0.0625% levobupivacaine (basal infusion rate of 3 mL/h, patient-controlled bolus dose of 3 mL, and lockout time of 20 min). Both approaches provided similar postoperative analgesia; however, local anesthetic consumption was larger in the popliteal group (4.9 +/- 1.4 mL/h) compared with the subgluteal group (3.8 +/- 1.1 mL/h; P < 0.05). We conclude continuous postoperative analgesia using stimulating catheters was effective at both injection sites; however, a subgluteal approach reduced the overall amount of local anesthetic.

Analgesia, Patient-Controlled↗
PubMed2005

High thoracic epidural anesthesia and coronary artery disease in surgical and non-surgical patients.

PURPOSE OF REVIEW: Even though high thoracic epidural anesthesia has been shown to be highly efficacious in the control of symptoms in refractory angina, its general use is still restricted. In patients who undergo coronary revascularization, however, the technique is becoming more and more popular. The present review outlines the use of high thoracic epidural anesthesia in patients with ischemic heart disease who underwent coronary revascularization in order to further reveal high thoracic epidural anesthesia's low complication rate and to analyze why physicians still refrain from using it more frequently. RECENT FINDINGS: The incidence of severe hemodynamic complications after high thoracic epidural anesthesia is low in patients with coronary artery disease. The main advantage would be a myocardial sympathectomy leading to an improvement in the oxygen input-demand relationship. Likewise, a decrease in mortality due to respiratory complications could not be shown. In patients undergoing myocardial revascularization with full anticoagulation there is an increased risk of epidural hematoma formation. Its precise risk is difficult to evaluate. There is an overall low rate of epidural hematomas as a result of high thoracic epidural anesthesia. With the available data, the incidence has been estimated at between 1/1500 and 1/10,000. SUMMARY: Epidural anesthesia does not decrease mortality or the incidence of myocardial infarction after coronary artery bypass grafting. It reduces the incidence of arrhythmias and respiratory complications and improves the quality of analgesia. High thoracic epidural anesthesia has been shown to be a safe and efficient technique for refractory angina that reduces the frequency of ischemic events and improves the clinical condition of patients.

Journal Article↗
PubMed2005

Plantar flexion seems more reliable than dorsiflexion with Labat's sciatic nerve block: a prospective, randomized comparison.

Labat's classic approach to the sciatic nerve has not been able to show which motor response of the foot provides a more frequent rate of complete sensory and motor block. In this prospective, randomized, double-blind study, we compared plantar flexion with dorsiflexion with regard to onset time and efficacy of sciatic nerve block using the classic posterior approach. A total of 80 patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block after evoked plantar flexion (n=40) or dorsiflexion (n=40). Twenty milliliters of 0.75% ropivacaine was injected after the motor response was elicited at <0.5 mA. Success rate was defined as complete sensory and motor block in all sciatic nerve distributions associated with a pain-free surgery. Time required for onset of sensory and motor block of the foot was recorded. Success was more frequent after elicited plantar flexion (87.5%) than dorsiflexion (55%; P <0.05). Onset of complete sensory and motor block of the foot was faster after elicited plantar flexion (10 +/- 10 min and 13 +/- 10 min, respectively) compared with dorsiflexion (20 +/- 11 min and 24 +/- 12 min; P <0.05). We conclude that plantar flexion of the foot predicts a shorter onset time and a more frequent success rate than dorsiflexion with Labat's classic posterior sciatic nerve block.

Adolescent↗
PubMed2005

Does the site of injection distal to the greater trochanter make a difference in lateral sciatic nerve blockade?

UNLABELLED: The two components of the sciatic nerve become more distant from one another in their course down the lower limb. This may have clinical implications if a small volume of local anesthetic is used with a single injection technique. In this prospective, randomized, double-blind study, we compared two different injection sites, 20 cm and 30 cm distal to the greater trochanter, in terms of onset time and success rate of sciatic nerve blockade after a single injection of 20 mL of 1.5% mepivacaine. Fifty patients undergoing foot surgery were randomly allocated to receive a lateral sciatic nerve blockade using one of 2 levels: 20 cm distal to the greater trochanter (group proximal; n = 25) and 30 cm distal to the greater trochanter (group distal; n = 25). Twenty milliliters of 1.5% mepivacaine was injected after a flexion plantar response was obtained at <0.5 mA. Time required for onset of sensory and motor blockade of the foot was recorded. Success rate was defined as complete sensory and motor blockade in all sciatic nerve distributions associated with a pain-free surgery. Onset of complete sensory and motor blockade was faster in group proximal (12 +/- 7 min and 15 +/- 8 min, respectively) compared with group distal (19 +/- 9 min and 23 +/- 9 min; P < 0.05). Group proximal also had a more frequent success rate compared with group distal (88% versus 56%, respectively; P < 0.05). It is concluded that in lateral sciatic nerve blockade, a more proximal approach to the sciatic nerve predicts a shorter onset time and more frequent success than a more distal injection site when a single injection and a small volume of local anesthetic is used. IMPLICATIONS: In lateral sciatic nerve blockade, a more proximal approach to the sciatic nerve provides shorter onset times and more frequent success than a more distal injection site when a single injection of 20 mL of mepivacaine 1.5% is used.

Adolescent↗
PubMed2004

Sciatic nerve block via posterior Labat approach is more efficient than lateral popliteal approach using a double-injection technique: a prospective, randomized comparison.

BACKGROUND: For peripheral nerve blockade, the double-injection technique proved to be superior to a single injection in previous investigations. The current study was designed to compare onset time and efficacy of two different double-injection approaches for sciatic nerve block with 0.75% ropivacaine. METHODS: A total of 50 patients undergoing foot surgery were randomly assigned to receive sciatic nerve blockade by means of the classic (Labat) posterior approach (n = 25) or a lateral popliteal approach (n = 25). All blocks were performed with the use of a nerve stimulator, and both major components of the sciatic nerve (tibial and common peroneal nerves) received separately 10 ml ropivacaine, 0.75%. Success rate was defined as a complete sensory and motor block associated with pain-free surgery. RESULTS: A greater success rate was observed in the classic group (96%) as compared with the popliteal group (68%; P < 0.05). A general anesthetic became necessary in six patients (24%) with the lateral popliteal approach and none with the classic approach (P < 0.05). The onset of complete sensory and motor blockade was significantly faster in the classic group (12 +/- 6 min) as compared with the popliteal group (26 +/- 10 min; P < 0.05). CONCLUSION: A double injection with a relatively low volume of 0.75% ropivacaine generated a higher success rate and a shorter onset time of sensory and motor blockade after the classic Labat approach than after a lateral popliteal approach.

Adolescent↗
PubMed2004

Lower extremity nerve blocks.

PURPOSE OF REVIEW: The purpose of this review is to present the most important recent studies into the clinical use of peripheral nerve blocks for anesthesia and postoperative analgesia of the lower limb surgery. RECENT FINDINGS: There is increasing interest in lower extremity peripheral nerve blocks because of their potential advantages and concerns over interactions of centroneuraxis blocks and anticoagulants. Several authors have studied different approaches to the blockade of peripheral nerves with their advantages or disadvantages. Continuous peripheral nerve blocks have showed prolonged analgesia and great patient satisfaction with low side effects. Recent imaging techniques (e.g. ultrasound, magnetic resonance, tomography scans) have been developed to improve the performance of lower peripheral nerve blocks. Finally, complications of these techniques have been examined. SUMMARY: Introduction of new methods and techniques are increasing and improving the use of lower peripheral nerve blocks. These techniques are gaining interest after the important increase of the lower molecular weigh heparins.

Journal Article↗
PubMed2004

The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine.

UNLABELLED: We studied three different injection techniques of sciatic nerve block in terms of block onset time and efficacy with 0.75% ropivacaine. A total of 75 patients undergoing foot surgery were randomly allocated to receive sciatic nerve blockade by means of the classic posterior approach (group classic; n = 25), a modified subgluteus posterior approach (group subgluteus; n = 25), or a lateral popliteal approach (group popliteal; n = 25). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 2-0.5 mA) and 30 mL of 0.75% ropivacaine. Onset of nerve block was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot. In the three groups, an appropriate sciatic stimulation was elicited at <0.5 mA. The failure rate was similar in the three groups (group popliteal: 4% versus group classic: 4% versus group subgluteus: 8%). The onset of nerve block was slower in group popliteal (25 +/- 5 min) compared with group classic (16 +/- 4 min) and group subgluteus (17 +/- 4 min; P < 0.001). There was no significant difference in the onset of nerve block between group classic and group subgluteus. No differences in the degree of pain measured at the first postoperative administration of pain medication were observed among the three groups. We conclude that the three approaches resulted in clinically acceptable anesthesia in the distribution of the sciatic nerve. The subgluteus and classic posterior approaches generated a significantly faster onset of anesthesia than the lateral popliteal approach. IMPLICATIONS: Comparing three different approaches to the sciatic nerve with 0.75% ropivacaine, the classic and subgluteal approaches exhibited a faster onset time of sensory and motor blockade than the lateral popliteal approach.

Adolescent↗
PubMed2003

Intradermal sufentanil does not improve lidocaine-induced local anesthesia.

PURPOSE: Peripheral opioid receptors may result in antinociceptive effects when occupied by opioids. This study examined intradermally injected sufentanil (S), a highly lipid soluble opioid, administered with and without lidocaine (L), in a thermal pain model. METHODS: Nine volunteers were instructed on the method of magnitude estimation of pain before undergoing baseline testing with seven seconds thermal stimuli between 44 and 52 degrees C, delivered by a contact thermal stimulator at five cutaneous forearm sites. Then, four sites randomly received injections of equal volumes (0.1 mL) of either normal saline (NS), lidocaine 0.5% (L), sufentanil 0.75 microg (S), lidocaine 0.5% plus sufentanil 0.75 microg (L+S), and one site was not injected and served as reference (REF). Testing was repeated at six, 30, 60, 90, 120, and 150 min following injection. The pain elicited by each stimulus was normalized to the subject's response to the 50 degrees C stimulus at the REF site. RESULTS: Baseline testing showed small (P = ns) differences in pain scores. At six minutes, the lidocaine sites (L, L+S) had pain scores that were mean 83% (range 78-88%) lower than the other sites (P < 0.05), but there was no difference between the L and L+S sites or between the S and NS or REF sites. At 30 and 60 min these pain scores were mean 38% (29-44%) and 20% (8-30%) less than at the REF, NS, and S sites (P = ns). At 90 min and later times, the pain scores had returned to baseline. CONCLUSIONS: These results suggest that intradermal sufentanil alone has no analgesic effect. Further, in combination with lidocaine, sufentanil does neither potentiate nor prolong the analgesic effect of lidocaine.

Adult↗
PubMed2003

Bilateral intravenous regional anesthesia: a new method to test additives to local anesthetic solutions.

BACKGROUND: Ketorolac, when added to lidocaine, has been shown to reduce early tourniquet pain during intravenous regional anesthesia (i.v.RA) in patients. Although the effectiveness of ropivacaine 0.2% for i.v.RA is equal to that of lidocaine 0.5% but significantly reduces central nervous system side effects after release of the tourniquet, it provides no advantage with regard to tourniquet tolerance times. Simultaneous bilateral i.v.RA with ropivacaine 0.2% was used to test the hypothesis that ketorolac modifies tourniquet tolerance and to test whether drug combinations can be evaluated in one study session. METHODS: Ten healthy, unsedated volunteers received 30 ml of ropivacaine 0.2% in each upper arm with 2 ml of normal saline in one arm and 30 mg of ketorolac in the contralateral arm for i.v.RA. Both proximal tourniquets remained inflated for 30 min, followed by inflation of the distal tourniquets and release of the proximal ones. Verbal numeric scores for tourniquet pain were recorded for both extremities. Central nervous system side effects were graded after release of each distal tourniquet. RESULTS: There was no difference between the two upper extremities with regard to surgical anesthesia and tourniquet tolerance. Total tourniquet tolerance was a median of 58.5 min (range, 45-90 min) and 60.5 min (39-79 min) in the normal saline and ketorolac groups, respectively. After release of the distal tourniquets, 5 of 10 volunteers experienced mild dizziness. CONCLUSIONS: The addition of ketorolac to ropivacaine does not improve tourniquet tolerance. Minimal central nervous system side effects after tourniquet release suggest that a total of 60 ml ropivacaine 0.2% for bilateral i.v.RA is a useful model for comparison of i.v.RA drug combinations.

Adult↗
PubMed2002

Central nervous system side effects are less important after iv regional anesthesia with ropivacaine 0.2% compared to lidocaine 0.5% in volunteers.

PURPOSE: Following release of a double tourniquet for intravenous regional anesthesia (IVRA), ropivacaine was shown to have a longer duration of action and less central nervous system (CNS) side effects than lidocaine. This study examines the correlation of CNS side effects to plasma levels of lidocaine 0.5% and ropivacaine 0.2% when injected intravenously for IVRA. METHODS: In a double-blind, cross-over study, ten volunteers received IVRA with 40 mL ropivacaine 0.2% or lidocaine 0.5% at least four days apart. Both cuffs of a double-cuff tourniquet remained inflated until they could no longer be tolerated. The incidence, duration and intensity of CNS side effects were recorded at three, ten, and 30 min after tourniquet release and correlated with simultaneous venous blood samples. RESULTS: There was a lower incidence of CNS side effects with ropivacaine (6/10 volunteers) when compared to lidocaine (10/10 volunteers). There was also less duration of these side effects (mean +/- SD, 5.1 +/- 5.2 min vs 11.7 +/- 6.7 min). Measured total plasma levels were highest at ten minutes with ropivacaine 0.2% (1.2 +/- 0.3 microg.mL(-1)) and at three minutes with lidocaine 0.5% (1.7 +/- 0.6 microg.mL(-1)). Peak CNS symptoms correlated with measured venous plasma levels for lidocaine, but occurred earlier with ropivacaine. CONCLUSIONS: We observed a lower incidence of CNS side effects with ropivacaine as compared to lidocaine. Although ropivacaine's greater lipid solubility should, theoretically, lead to more CNS side effects, this was, likely, offset by slower release from tissues and lesser percentage of unbound (free) drug.

Amides↗
PubMed2002

Levobupivacaine 0.125% and lidocaine 0.5% for intravenous regional anesthesia in volunteers.

BACKGROUND: Levobupivacaine, a long acting, amino-amide, local anesthetic, may offer advantages over lidocaine for intravenous regional anesthesia (IVRA). The objective of this investigation was to compare levobupivacaine to lidocaine for IVRA. METHODS: After institutional review board approval and informed consent, eight unpremedicated male American Society of Anesthesiologists (ASA) I-II volunteers received 40 ml of levobupivacaine 0.125% or lidocaine 0.5% for IVRA on separate days. Onset and regression of sensory anesthesia by pinprick, transcutaneous electrical stimulation (TES), and of motor function were tested before, during, and after release of the tourniquet. Central nervous system and cardiac side effects were evaluated after local anesthetic administration and tourniquet release. The tourniquet remained inflated for 30-45 min. RESULTS: Intravenous regional anesthesia with either agent provided surgical anesthesia. Sensory anesthesia to pinprick (lateral antebrachial cutaneous nerve) was faster with lidocaine at median 1.5 min. versus 12.5 min with levobupivacaine. Loss of sensation to TES occurred at median 22.5 and 27.5 min for lidocaine and levobupivacaine, respectively. Loss of motor function occurred earlier after lidocaine administration. After release of the tourniquet, return of sensation to TES, pinprick (ulnar nerve), and return of motor function occurred later with levobupivacaine at median 25, 15, and 21.25 versus 10, 4.5, and 10 min with lidocaine. Central nervous system side effects were absent in volunteers given levobupivacaine, but five of eight volunteers given lidocaine experienced mild side effects. No cardiac events were noted. CONCLUSIONS: Levobupivacaine 0.125% may be an alternative to lidocaine 0.5% for IVRA. Longer lasting analgesia after release of the tourniquet may be caused by a more profound and prolonged tissue binding effect of levobupivacaine.

Adult↗
PubMedDate not supplied

Sedation after spinal anesthesia in elderly patients: a preliminary observational study with the PSA-4000.

PURPOSE: Neuraxial blockade is known to have a sedative effect, decreasing the need for inhalational and iv anesthetic agents. The purpose of the present study was to quantify the sedative effect of spinal anesthesia and to determine the time of maximum sedation. METHODS: This is an observational study in which 20 unsedated patients were scheduled to undergo urologic and orthopedic surgeries under spinal anesthesia. Patients with pre-existing neurological conditions or receiving psychotropic medications were excluded from the study. All received 1.5 mL (11.25 mg) of hyperbaric bupivacaine 0.75% intrathecally. No sedative or narcotic was administered intravenously or intrathecally. The Patient State Analyzer, (PSA-4000) was used to monitor sedation along with Observer's Assessment of Alertness and Sedation (OAA/S) scores every five minutes. Differences in patient state index (PSI) and OAA/S scores are expressed as median and range and were evaluated by Wilcoxon's signed rank test for non-parametric data; P < 0.05 was considered significant. PSI, OAA/S and time at lowest score are expressed as median(range). RESULTS: PSI scores decreased from baseline 99 (96-99) to 78 (56-87) at 35(14.5-54) min into the spinal anesthetic (P < 0.05). OAA/S scores decreased from baseline 5 to 4 (range 3-5) at the time of the lowest PSI scores (P < 0.05). CONCLUSIONS: In this elderly patient population, spinal anesthesia induced changes in the processed electroencephalogram with reduction in PSI and OAA/S scores. The reduction in afferent input to the reticular activating system could possibly explain the sedation that has been observed and the reduction in the PSA scores.

Aged↗
PubMedDate not supplied

Lateral approach to the sciatic nerve block in the popliteal fossa: correlation between evoked motor response and sensory block.

BACKGROUND AND OBJECTIVES: The purpose of this study was to identify which of two motor responses of the foot (plantar flexion versus dorsiflexion) best predicts complete sensory blockade of the sciatic nerve when is used for lateral popliteal sciatic nerve block. METHODS: Thirty American Society of Anesthesiologist physical status I or II patients scheduled for foot and ankle surgery under lateral popliteal sciatic nerve block were enrolled in the study. During each block, the needle was placed to evoke one of the following motor responses of the foot: plantar flexion or dorsiflexion. Thirty milliliters of 0.75% ropivacaine was injected after the motor response was elicited at <0.5 mA. The sequence of elicited motor response was randomized. Sensory blockade of the areas of the foot innervated by the deep peroneal, superficial peroneal, posterior tibial, and sural nerves was checked in a blinded manner. Time required for onset of sensory and motor block of the foot was recorded. RESULTS: The 2 groups were similar with regard to demographic variables and type of surgery. The total of nerves blocked (deep and superficial peroneal, posterior tibial, and sural nerves) after elicited plantar flexion was greater (complete sensory block in 58 of 60 nerve distributions) than after elicited dorsiflexion (34 of 60 nerve distributions) (P <.05). Onset of complete sensory and motor blockade of the foot was faster after elicited plantar flexion (16.6 +/- 5.1 minutes, 20.1 +/- 5.1 minutes, respectively) than after elicited dorsiflexion (24.3 +/- 5.1 minutes, 28.1 +/- 5.0 min, P <.05). CONCLUSIONS: After stimulation of the sciatic nerve, plantar flexion better predicts complete sensory blockade of the foot than dorsiflexion when using the lateral approach to the popliteal fossa. The findings of the present study apply to a single injection of 30 mL of ropivacaine 0.75%.

Adolescent↗
PubMedDate not supplied

Lateral approach to the sciatic nerve in the popliteal fossa: a comparison between 1.5% mepivacaine and 0.75% ropivacaine.

BACKGROUND AND OBJECTIVES: Ropivacaine and mepivacaine are commonly used local anesthetics for peripheral nerve blockade. The purpose of the present study was to compare onset time, quality of anesthesia, and duration of analgesia with ropivacaine 0.75% and mepivacaine 1.5% for lateral popliteal nerve block. METHODS: Fifty American Society of Anesthesiologists (ASA) physical status I or II patients scheduled for foot and ankle surgery with calf tourniquet under lateral popliteal sciatic nerve block were randomly assigned to receive 30 mL of either ropivacaine 0.75% or mepivacaine 1.5%. Time required for onset of sensory and motor block, resolution of motor blockade, onset of postsurgical pain, and time of first analgesic medication were recorded. RESULTS: The 2 groups were similar with regard to demographic variables and duration of surgery. Onset of sensory and motor block was significantly shorter in the mepivacaine group (9.9 +/- 3.3 min and 14.7 +/- 3.6 min, respectively) than in the ropivacaine group (18.1 +/- 6.1 min and 23.6 +/- 5.5 min, respectively) (P < 0.001). Resolution of motor block occurred later in the ropivacaine group than in the mepivacaine group (P < 0.001), and duration of postoperative analgesia was significantly longer in the ropivacaine group (19 +/- 3.4 h) compared with the mepivacaine group (5.9 +/- 1.1 h) (P < 0.001). Analgesic requirements were higher in mepivacaine group than in the ropivacaine group (P < 0.001). There were 2 failed blocks, one in each group. CONCLUSIONS: Both ropivacaine and mepivacaine provided effective sciatic nerve blockade. Mepivacaine 1.5% displayed a significantly shorter onset time than ropivacaine 0.75%. Postoperatively, ropivacaine 0.75% resulted in longer-lasting analgesia and less need for oral pain medication.

Adolescent↗
PubMedDate not supplied

A comparison of lateral popliteal versus lateral midfemoral sciatic nerve blockade using ropivacaine 0.5%.

BACKGROUND AND OBJECTIVES: The midfemoral approach to the sciatic nerve (MF) is a new technique that has been used for postoperative analgesia after knee surgery. The aim of the present study was to compare efficacy, performance time, and patient acceptance of the midfemoral approach to that of the lateral approach at the level of the popliteal fossa (popliteal block [PB]). METHODS: Sixty-three patients were enrolled in this prospective, randomized study. Thirty-two patients received a lateral sciatic nerve block (group PB) and 31 patients a midfemoral block (group MF). Ropivacaine 0.5% (30 mL) was used in both groups. RESULTS: The quality of nerve blockade was comparable in both groups. Onset of sensory block for peroneal and tibial nerves was significantly shorter in group MF than in group PB, 5 (1-20) minutes and 5 (1-20) minutes versus 10 (1-40) minutes and 10 (1-45) minutes, respectively. Onset of motor block in both territories was also shorter in group MF compared with PB, 6 (2-35) minutes and 5 (2-55) minutes versus 15 (2-60) minutes and 15 (2-60) minutes, respectively (P <.05). There was no difference in duration of sensory and motor blockade, 16 (7-32) hours versus 16 (6-43) hours and 16 (8-32) hours versus 16 (6-25) hours. There was no significant difference between both groups with respect to difficulty of nerve block performance. Patient discomfort during needle puncture was also similar. CONCLUSIONS: The midfemoral approach to the sciatic nerve for ankle and foot surgery resulted in a reliable anesthetic, comparable to that of the lateral popliteal approach. This technique is simple, safe, and provides postoperative analgesia as effective as that obtained with the lateral approach.

Adult↗