The success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance: A clinical trial study for pain management in emergency departments

Rezvani Kakhki, Behrang; Ebrahimi, Mohsen; Foroughian, Mahdi; Khajeh Nasiri, Samaneh; Eslami, Vahid; Anavri Ardakani, Saeideh; Ahmadi, Sayyed Reza

doi:10.34172/jept.2020.43

Document Type : Original Article

Authors

¹ Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

² Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

³ University of Texas Health Science Center at San Antonio, Texas, USA

⁴ Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran

https://doi.org/10.34172/jept.2020.43

Abstract

Objective: The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. Methods: This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block in the ankle at the emergency department of Hashemi Nejad hospital and Edalatian emergency center in Mashhad, Iran. The eligible individuals were randomly assigned to one of two groups, designated the control (landmark-based nerve block) and the case group (ultrasound-guided nerve block). The two groups were compared in terms of the main measurable outcomes. The data were analyzed using SPSS software (version 20) by nonparametric tests. Results: According to the findings, the mean and median of nerve block success in the landmark-based and ultrasound-guided methods were significantly different between the two groups, both 15 (P=0.02) and 30 (P=0.001) min post-intervention. In this regard, nerve block with ultrasound guidance had a higher success rate compared to the landmark method. However, no significant difference between the two interventions was found in terms of the mean and median of the procedure duration (P=0.8) and injection frequency (P=0.4). On the other hand, the two groups were significantly different regarding the median and mean of patient satisfaction (P=0.00), duration of analgesia (P=0.004), and nerve block-related complications (P=0.03). Conclusion: The findings revealed that the relatively new technique of nerve block by ultrasound-guide resulted in better outcomes than the landmark-based method. Consequently, this method could be adopted to control acute pain in the emergency departments and improve patient care.

Keywords

Main Subjects

References

1. Benzon H, Raja SN, Fishman SE, Liu SS, Cohen SP. Essentialsof Pain Medicine E-book. Elsevier Health Sciences; 2011.

2. Vrachatis AD, Alpert MA, Georgulas VP, Nikas DJ, Petropoulou EN, Lazaros GI, et al. Comparative efficacy of primary angioplasty with stent implantation and thrombolysis in restoring basal coronary artery flow in acute ST segment elevation myocardial infarction: quantitative assessment using the corrected TIMI frame count. Angiology 2001; 52(3): 161-6. doi: 10.1177/000331970105200301.

3. Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology 2006; 104(2): 368-73. doi: 10.1097/00000542-200602000-00024.

4. Blaivas M, Lyon M. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED. Am J Emerg Med 2006; 24(3): 293-6. doi: 10.1016/j.ajem.2005.10.004.

5. Chan VW. Applying ultrasound imaging to interscalene brachial plexus block. Reg Anesth Pain Med 2003; 28(4): 340-3. doi: 10.1016/s1098-7339(03)00189-5.

6. Wegener JT, Boender ZJ, Preckel B, Hollmann MW, Stevens MF. Comparison of percutaneous electrical nerve stimulation and ultrasound imaging for nerve localization. Br J Anaesth 2011; 106(1): 119-23.

7. van Geffen GJ, van den Broek E, Braak GJ, Giele JL, Gielen MJ, Scheffer GJ. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciaticnerve block at the popliteal fossa. Anaesth Intensive Care 2009; 37: 32–7.

8. Mariano ER, Loland VJ, Sandhu NS, Bishop ML, Lee DK, Schwartz AK, et al. Comparative efficacy of ultrasoundguided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia. Can J Anaesth 2010; 57: 919-26.

9. Avellanet M, Sala-Blanch X, Rodrigo L, Gonzalez-Viejo MA. Permanent upper trunk plexopathy after interscalene brachial plexus block. J Clin Monit Comput 2016; 30(1): 51-4. doi: 10.1007/s10877-015-9681-z.

10. Shinn HK, Kim BG, Jung JK, Kwon HU, Yang C, Won J. Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: a case report. Medicine (Baltimore) 2016; 95(24): e3891. doi: 10.1097/ md.0000000000003891.

11. Kahn RL, Ellis SJ, Cheng J, Curren J, Fields KG, Roberts MM, et al. The incidence of complications is low following foot and ankle surgery for which peripheral nerve blocks are used for postoperative pain management. HSS J 2018; 14(2): 134-42. doi: 10.1007/s11420-017-9588-y.

12. Claudio R, Hadzic A, Shih H, Vloka JD, Castro J, KoscielniakNielsen Z, et al. Injection pressures by anesthesiologists during simulated peripheral nerve block. Reg Anesth Pain Med 2004; 29(3): 201-5. doi: 10.1016/j.rapm.2003.12.013.

13. Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasoundguided supraclavicular brachial plexus block. Anesth Analg 2003; 97(5): 1514-7. doi: 10.1213/01. ane.0000062519.61520.14.

14. De Andrés J, Sala-Blanch X. Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med 2002; 27(1): 77-89.

15. Hua D, Wang Y, Ji S, Zha J, Xia Y. Ultrasound-guided brachial plexus block: comparison between inter scalene and supraclavicular approach. J Med Imaging Health Inform 2019; 9(5): 951-5. doi: 10.1166/jmihi.2019.2658.

16. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg 2003; 97(5): 1518-23. doi: 10.1213/01. ane.0000086730.09173.ca.

17. Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 2007; 54(3): 176-82. doi: 10.1007/bf03022637.

18. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med 2008; 33(3): 259-65. doi: 10.1016/j.rapm.2007.10.010.

19. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008; 33(3): 253-8. doi: 10.1016/j. rapm.2007.10.011.

20. Liu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med 2009; 34(1): 47-59. doi: 10.1097/ AAP.0b013e3181933ec3.

21. Grau T, Fatehi S, Motsch J, Bartusseck E. [Survey on current practice of regional anaesthesia in Germany, Austria, and Switzerland. Part 2: use, success rates and techniques]. Anaesthesist 2004; 53(9): 847-55. doi: 10.1007/s00101-004- 0720-2.

22. Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG, et al. Ultrasonography for ilioinguinal/ iliohypogastric nerve blocks in children. Br J Anaesth 2005; 95(2): 226-30. doi: 10.1093/bja/aei157.

23. Mohamed KH, Abdelrahman KA, Elameer AN, Ali IH. Morphine as an adjuvant to local anesthetics in axillary brachial plexus block in forearm and hand surgery. J Curr Med Res Pract 2019; 4(2): 131-6. doi: 10.4103/jcmrp. jcmrp_35_19.

24. Sandhu NS, Maharlouei B, Patel B, Erkulwater E, Medabalmi P. Simultaneous bilateral infraclavicular brachial plexus blocks with low-dose lidocaine using ultrasound guidance. Anesthesiology 2006; 104(1): 199- 201. doi: 10.1097/00000542-200601000-00028.

25. Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med 2009; 34(3): 256- 60. doi: 10.1097/AAP.0b013e3181a343a2.

26. Andrew T. Ultrasound Guidance for Regional Anesthesia. In: Miller R.D. Miller’s Anesthesia. 7th ed. California:alifornia: Elsevier; 2010. p. 1675.

27. Bigeleisen PE. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology 2006; 105(4): 779-83. doi: 10.1097/00000542-200610000-00024.

28. Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, et al. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med 2004; 29(5): 417-23. doi: 10.1016/j.rapm.2004.06.002.

29. Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg 2007; 104(5): 1265-9, tables of contents. doi: 10.1213/01.ane.0000260614.32794.7b.

Journal of Emergency Practice and Trauma

The success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance: A clinical trial study for pain management in emergency departments

References

References

Volume 7, Issue 1
January 2021
Pages 12-16

The success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance: A clinical trial study for pain management in emergency departments

References

References

Volume 7, Issue 1January 2021Pages 12-16

Volume 7, Issue 1
January 2021
Pages 12-16