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PubMed2004

Continuous parasacral sciatic block: a radiographic study.

UNLABELLED: Parasacral sciatic blockade results in anesthesia of the entire sacral plexus. In this study we sought to determine the spread of the local anesthetic injected through a parasacral catheter, the anatomical location of the inserted catheters, and the extent and reliability of the blockade. In this study, 87 consecutive patients undergoing major lower limb surgery were enrolled. After placement of the catheter and injection of 8 mL of radio-opaque contrast dye, radiographic images were evaluated for dispersion of the injectate. Sensory and motor evaluations were also performed. Radiographic analysis of the injectates revealed that nearly all catheters (86 catheters, 99%) were in the correct anatomical position. The mean volume of local anesthetic injection was 21 +/- 3 mL. All patients developed a full sensory block of all three major components of the sciatic plexus (tibial, common peroneal, and posterior cutaneous nerve of the thigh). We conclude that the parasacral sciatic block results in frequent success of blockade of all three major components of the sciatic plexus and it has a small risk of complications. Contrast radiography can be used to document the catheter placement. IMPLICATIONS: The parasacral sciatic block results in a frequent success rate of blockade of all three major components of the sciatic plexus (tibial, common peroneal, and cutaneous nerve of thigh). A contrast radiography can be used to confirm the proper position of the catheter.

Adolescent↗

PubMedDate not supplied

Continuous lumbar plexus block: Use of radiography to determine catheter tip location.

BACKGROUND AND OBJECTIVES: The purpose of this article is to document where a lumbar plexus catheter introduced by the posterior approach will track and to evaluate the benefit of using systematic radiographic verification of catheter placement. METHODS: A continuous lumbar plexus block (CLPB) by the posterior approach was performed on 169 consecutive adult patients scheduled for major hip, thigh, or knee surgery. Each catheter was verified by radiography using 10 mL contrast medium. The correct position of the catheter showed a caudally and laterally oriented contrast spindle. RESULTS: Epidural spread of the contrast medium occurred in 3 of 169 patients (1.8%). Only 1 patient had a clinically relevant epidural spread of local anesthetic. Successful block of the lumbar plexus was achieved in the other 166 cases. CONCLUSIONS: Epidural spread of local anesthetic during lumbar plexus block should be expected to be relatively common. It can be easily identified clinically with fractionated doses of local anesthetic. The catheter tip was identified in the epidural space by radiographic verification in only 1.8% of cases. This expensive procedure is therefore unnecessary except when an unusual location is suspected, but not necessary to confirm a catheter assumed to be correctly positioned.

Aged↗