Ultrasound-guided popliteal sciatic nerve blockade in the severely and morbidly obese: a prospective and randomized study

Soberon, Jose R., McInnis, Carrie, Bland, Kim S., Egger, Allison L., Patterson, Matthew E., Elliott, Clint E., Treuting, Robert J. and Osteen, Kristie (2016) Ultrasound-guided popliteal sciatic nerve blockade in the severely and morbidly obese: a prospective and randomized study. Journal of Anesthesia, 30 3: 397-404. doi:10.1007/s00540-016-2143-z


Author Soberon, Jose R.
McInnis, Carrie
Bland, Kim S.
Egger, Allison L.
Patterson, Matthew E.
Elliott, Clint E.
Treuting, Robert J.
Osteen, Kristie
Title Ultrasound-guided popliteal sciatic nerve blockade in the severely and morbidly obese: a prospective and randomized study
Journal name Journal of Anesthesia   Check publisher's open access policy
ISSN 1438-8359
0913-8668
Publication date 2016-06-01
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s00540-016-2143-z
Open Access Status Not Open Access
Volume 30
Issue 3
Start page 397
End page 404
Total pages 8
Place of publication Kudan-kita, Tokyo, Japan
Publisher Springer Japan KK
Collection year 2017
Language eng
Formatted abstract
Purpose: Limited research data exist regarding optimal block techniques in the severely and morbidly obese patient population. We compared two approaches to sciatic nerve blockade at the popliteal fossa in severely and morbidly obese patients. The purpose of this study was to identify differences in pain scores, block onset characteristics, and adverse events between the proximal (prebifurcation) and the distal (postbifurcation) sites.

Methods: Patients with a body mass index ≥35 scheduled for unilateral foot surgery with a popliteal block were randomized to receive an ultrasound-guided popliteal block proximal or distal to the bifurcation of the sciatic nerve. The primary endpoint was numerical rating scale (NRS) scores in the post anesthesia care unit (PACU).

Results: Thirty patients were enrolled in each group for a total of 60 participants. Patients in the distal group had lower NRS scores upon entry into the PACU (0.70 ± 1.91) compared with the proximal group (2.17 ± 3.37), had a faster onset of sensorimotor blockade, and were less likely to require a repeat block procedure, conversion to general anesthesia, or local anesthetic supplementation by the surgical team. There was no difference in block procedure times or incidence of nerve injury between the two groups.

Conclusions: The distal approach to the popliteal block provided several intraoperative and analgesic benefits without a difference in block procedural times in the severely and morbidly obese. It is a cost-free intervention that results in a higher likelihood of a successful block in a population where avoidance of opioids is desirable.
Keyword Foot (or) ankle surgery
Postoperative pain
Regional anesthesia
Sciatic (or) popliteal block
Severe (or) morbid obesity
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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