To determine the relationship between perineural catheter location along the sciatic nerve (popliteal versus subgluteal placement) and infusion effects for ultrasound-guided continuous sciatic nerve blocks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
2
Patients randomized to this group will receive a sciatic nerve block with the catheter tip insertion at the subgluteal location 1-3 cm caudad to the inferior border of the gluteus maximus muscle. After catheter placement, outcome measures will be assessed.
Patients randomized to this group will receive a sciatic nerve block with the catheter tip insertion at the popliteal location 1-3 cm cephalad to the sciatic bifurcation. After Catheter placement outcome measures will be assessed.
UCSD Medical Center, Thornton
La Jolla, California, United States
UCSD Medical Center Hillcrest
San Diego, California, United States
Muscle Strength (MVIC) of the hamstring muscles
We will evaluate hamstring strength which is innervated by the sciatic nerve with an isometric force electromechanical dynamometer to measure the force produced during a maximum voluntary isometric contraction (MVIC) in a seated position with the knees flexed at 90º
Time frame: 08:00-09:00 morning after surgery as a percentage of baseline
Sensory Effect
We will evaluate tolerance of transcutaneous electrical stimulation. Electrocardiogram pads will be placed on the plantar and dorsal aspects of the foot, and attached to a nerve stimulator. The current will be increased from 0 mA until subjects described a "buzzing" sensation (not painful), at which time the current will be recorded as the tolerated level and the nerve stimulator turned off.
Time frame: 08:00-09:00 morning after surgery
Pain Scores
Surgical pain scores both average and worse as collected by nursing staff; and also the average and worse pain during the primary endpoint measurement
Time frame: from leaving the PACU until 08:00 the morning after surgery
Sleep Disturbances
Total number of times patient woke in the night due to surgical pain.
Time frame: recorded at 08:00-09:00 the morning after surgery for the previous night
Total Infusion
Total infusiond duration in time and volume and total number of boluses delivered via catheter.
Time frame: recorded at 08:00-09:00 the morning following Surgery
Anesthetic Leakage
Leakage from the catheter site noted by patient.
Time frame: recorded at 08:00-09:00 the morning following Surgery
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analgesic consumption
Hourly analgesic consumption.
Time frame: end of PACU stay until 08:00-09:00 the morning following surgery