Key result
Ultrasound-guided sciatic nerve blockade administered by nurse anesthetists trended toward lower immediate postoperative opioid requirements and pain scores compared to nerve stimulator guidance, though differences were not statistically significant.
Why the study?
Does ultrasound-guided sciatic nerve blockade compared to nerve stimulator guidance improve postoperative analgesia in patients undergoing foot and ankle surgery?
Observational (n=48)
No
Does ultrasound-guided sciatic nerve blockade compared to nerve stimulator guidance improve postoperative analgesia in patients undergoing foot and ankle surgery?
Ultrasound-guided sciatic nerve blockade by nurse anesthetists may improve postoperative analgesia compared to nerve stimulator guidance, though opioid-tolerant patients remain challenging to manage.
Ultrasound guidance may improve analgesia after foot and ankle surgery; leaves open confirmation in larger randomized trials before practice change.
Introduction: Assessment of expertise in regional anesthesia techniques is traditionally based upon quota fulfillment of procedures during training. Validation of practitioner proficiency in performing procedures in surgical specialties has moved from simple measurement of technical skills to evaluation of global patient outcomes. Complete absence of pain as a result of nerve blockade is the most important clinical endpoint but patient, technical and procedural factors influence results. The purpose of this study was to measure the postoperative pain scores and Short Communication Lollo and Stogicza; BJMMR, 10(6): 1-12, 2015; Article no.BJMMR.19502 2 associated analgesic medication requirements for patients administered sciatic nerve blockade by nurse anesthetists and determine patient or procedural factors that influenced this outcome. Methods: Either nerve stimulator or ultrasound guided sciatic nerve blockade was administered by nurse anesthetists under the supervision of regional anesthesia faculty. Patient demographic data that was collected included gender, body mass index, surgical procedure, and pre-existing chronic pain with associated opioid use. Patient self-reported pain scores and opioid analgesic dosages in the preoperative, intraoperative, immediate postoperative and 24 hour post procedure intervals were recorded. Results: 22 nurse anesthetists administered sciatic nerve blockade to 48 patients during a 36 month interval. Transition from a nerve stimulator to ultrasound guided sciatic nerve block technique resulted in lower mean pain scores. Patients reporting chronic opioid use were observed to have elevated perioperative opioid analgesic requirements and pain scores compared to opioid naive patients. Conclusion: Effective analgesia is a prime measure for assessing expertise in regional anesthesia and continuous evaluation of this outcome in everyday practice is proposed.
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Lollo et al. (2015) conducted an observational in Elective foot and ankle surgery (n=48). Ultrasound-guided sciatic nerve blockade vs. Nerve stimulator-guided sciatic nerve blockade was evaluated on Postoperative pain scores and opioid analgesic requirements. Ultrasound-guided sciatic nerve blockade administered by nurse anesthetists trended toward lower immediate postoperative opioid requirements and pain scores compared to nerve stimulator guidance, though differences were not statistically significant.
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