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Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-blind Study

Børglum, Jens MD, PhD*; Johansen, Karina MD*; Christensen, Margrethe D. MD*; Lenz, Katja MD*; Bendtsen, Thomas F. MD, PhD; Tanggaard, Katrine*; Christensen, Anders F. MD, PhD; Moriggl, Bernhard MD, PhD§; Jensen, Kenneth MD, BBA*

Regional Anesthesia & Pain Medicine: January/February 2014 - Volume 39 - Issue 1 - p 18–25
doi: 10.1097/AAP.0000000000000030
Original Articles

Background and Objectives: We describe a new approach to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration dual-injection (SPEDI) technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. We introduce an alternative, effective, and possibly faster method.

Methods: Sixty patients undergoing leg and foot surgery under general anesthesia were included. We deposited 15 mL of ropivacaine 0.75% around the sciatic nerve (SCN) and 5 mL of ropivacaine 0.75% at the SAN. Patients were randomized to the popliteal-sciatic/saphenous technique or the SPEDI technique. The primary outcome measure was performance time. Positioning time, pain assessment, nausea in the postanesthesia care unit, sufentanil demand, dermatomal anesthesia, and degree of motor blockade were also recorded.

Results: Performance time was significantly faster with the SPEDI technique (median time, 110 seconds [range, 57–315 seconds] vs 246 seconds [range, 163–472 seconds]; P < 0.0001). Positioning time was significantly shorter with the SPEDI technique (P < 0.0001). No other statistically significant differences were recorded.

Conclusions: The SPEDI block resulted in significantly faster performance time and reduced positioning time with statistically equal efficacy in relation to pain assessment, nausea, sufentanil demand, dermatomal anesthesia, and motor blockade. The SPEDI block is statistically an equally effective alternative to the traditional popliteal-sciatic/saphenous block combination for leg and foot surgery, but it is faster, requires only 1 skin penetration, and does not require repositioning of the leg.

From the *Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark; †Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark; ‡Department of Radiology, Copenhagen University Hospital, Bispebjerg, Denmark; and §Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria.

Accepted for publication October 7, 2013.

Address correspondence to: Jens Børglum, MD, PhD, Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark (e-mail: jens.borglum@gmail.com).

The authors declare no conflict of interest.

The Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital (Bispebjerg, Denmark) financed this study.

Select preliminary data were presented by Dr K. Johansen et al at the 31st Annual European Society of Regional Anaesthesia and Pain Therapy Congress in Bordeaux, France, September 5–8, 2012, and by Dr M.D. Christensen et al at the Annual Meeting of the Danish Society for Anaesthesiology and Intensive Care Medicine in Copenhagen, Denmark, November 2012.

Copyright © 2014 by American Society of Regional Anesthesia and Pain Medicine.