Saphenous nerve block study in A and A

[excalibur]

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Most recent Anesthesia and Analgesia has an article comparing success rate of 2 USG above the knee saphenous nerve blocks and the below the knee field block.

The two USG nerve blocks were the Vastus medialis technique and the Perifemoral (artery) technique.

Conclusion: The above the knee USG saphenous nerve block had a much higher success rate, with the perifemoral approach having a 100% success rate-- 20 out of 20 pts.

A Comparison of Ultrasound-Guided and Landmark-Based Approaches to Saphenous Nerve Blockade: A Prospective, Controlled, Blinded, Crossover Trial
Michael L. Kent, MD, Robert J. Hackworth, MD, Robert. H. Riffenburgh, PhD, Julie L. Kaesberg, MD, David C. Asseff, MD, Eugenio Lujan, MD and John M. Corey, MD
Abstract

BACKGROUND: Blockade of the saphenous nerve is often used for surgeries below the knee. Depending on the approach, success rates vary widely ranging from 33% to 88%. In this prospective volunteer study, we compared 2 ultrasound-guided techniques, the modified vastus medialis and perifemoral saphenous nerve block with a below the knee field block.

METHODS: Twenty volunteer adults, in a single-blinded, crossover, prospective trial underwent 3 different saphenous nerve blocks. The primary end point of block success was loss of sensation in the distal two-thirds distribution of the saphenous nerve. Secondary variables included time to perform the block, time to sensory loss, pain during block, and motor weakness.

RESULTS: Compared with the below the knee field block success rate (30%), both the modified vastus medialis and perifemoral techniques had significantly higher success rates (80%, difference 50% with confidence interval [CI], 23%–77%, P = 0.009, and 100%, difference 70% with CI, 41%–91%, P < 0.001, respectively). However, the difference when comparing the perifemoral ultrasound technique against the modified vastus medialis ultrasound technique did not show significance (difference 20% with CI, &#8722;7% to 49%, P = 0.125). Also, no statistical differences were found with the other variables measured, except the perifemoral technique showed faster block performance times than below the knee field block (P = 0.007).

CONCLUSION: In our prospective study, we have demonstrated that ultrasound-guided above the knee saphenous nerve blocks have higher success rates than a below the knee field block and are easily performed in a short amount of time.

Anesthesia and Analgesia July 2013

 

[okayplayer]

At our high volume trauma center we have shifted to doing transsartorial perifemoral approach saphenous blocks and have noted significantly improved success with this approach. We haven't published anything recently on this that I'm aware of, but it has definitely become our approach of choice and anecdotally there seems to be a difference.

 

[etudiante04]

At our high volume trauma center we have shifted to doing transsartorial perifemoral approach saphenous blocks and have noted significantly improved success with this approach. We haven't published anything recently on this that I'm aware of, but it has definitely become our approach of choice and anecdotally there seems to be a difference.

Can't wait to access the full copy to address some of my questions. In the meantime,
Are the success rates as varied as reported above at your institution? (33-88 percent) and how does it reflect the anecdotal observations?

 

[BobBarker]

Anecdotally, our success rate with the subsartorial approach is higher than the below knee periveinous approach as well.

 

[BLADEMDA]

Block Success:

VM location: 80%
Perifemoral: 100%
Field Block: 30%

Successful block was defined as loss of sensory sensation to the distal two-thirds of the area measured



100% Success rate using 10 mls of local in the Perifemoral Area. ( I use 15-20 mls and have achieved extremely high success rates as well.
I prefer at least 15 mls of local as it increases the odds of filling the adductor canal)

 

[BLADEMDA]

 

[epidural man]

Most recent Anesthesia and Analgesia has an article comparing success rate of 2 USG above the knee saphenous nerve blocks and the below the knee field block.

The two USG nerve blocks were the Vastus medialis technique and the Perifemoral (artery) technique.

Conclusion: The above the knee USG saphenous nerve block had a much higher success rate, with the perifemoral approach having a 100% success rate-- 20 out of 20 pts.

A Comparison of Ultrasound-Guided and Landmark-Based Approaches to Saphenous Nerve Blockade: A Prospective, Controlled, Blinded, Crossover Trial
Michael L. Kent, MD, Robert J. Hackworth, MD, Robert. H. Riffenburgh, PhD, Julie L. Kaesberg, MD, David C. Asseff, MD, Eugenio Lujan, MD and John M. Corey, MD
Abstract

BACKGROUND: Blockade of the saphenous nerve is often used for surgeries below the knee. Depending on the approach, success rates vary widely ranging from 33% to 88%. In this prospective volunteer study, we compared 2 ultrasound-guided techniques, the modified vastus medialis and perifemoral saphenous nerve block with a below the knee field block.

METHODS: Twenty volunteer adults, in a single-blinded, crossover, prospective trial underwent 3 different saphenous nerve blocks. The primary end point of block success was loss of sensation in the distal two-thirds distribution of the saphenous nerve. Secondary variables included time to perform the block, time to sensory loss, pain during block, and motor weakness.

RESULTS: Compared with the below the knee field block success rate (30%), both the modified vastus medialis and perifemoral techniques had significantly higher success rates (80%, difference 50% with confidence interval [CI], 23%–77%, P = 0.009, and 100%, difference 70% with CI, 41%–91%, P < 0.001, respectively). However, the difference when comparing the perifemoral ultrasound technique against the modified vastus medialis ultrasound technique did not show significance (difference 20% with CI, &#8722;7% to 49%, P = 0.125). Also, no statistical differences were found with the other variables measured, except the perifemoral technique showed faster block performance times than below the knee field block (P = 0.007).

CONCLUSION: In our prospective study, we have demonstrated that ultrasound-guided above the knee saphenous nerve blocks have higher success rates than a below the knee field block and are easily performed in a short amount of time.

Anesthesia and Analgesia July 2013

I liked the cadaver pictures - cool stuff.