Saranteas Theodosios, Poulogiannopoulou Eleni, Riga Maria, Panagouli Konstantina, Mavrogenis Andreas, Papadimos Thomas
Second Department of Anaesthesiology, National and Kapodistrian University of Athens School of Medicine, Athens, Attica, 15349, Greece.
First Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, Attica, 15349, Greece.
F1000Res. 2024 Dec 2;13:1103. doi: 10.12688/f1000research.155381.2. eCollection 2024.
BACKROUND/OBJECTIVES: We investigated a technique that facilitates the coiling of a regular straight catheter (with integral stylet) behind the sciatic nerve in an ultrasound (US) regional anaesthesia simulator, and then applied our findings to a series of orthopedic-trauma patients.
We conducted a randomized study of two methods of perineural catheter advancement in a sciatic nerve block Blue Phantom simulator. Two groups of twenty catheters each (method A and method B) were evaluated under real-time ultrasound imaging. The needle in-plane/nerve in-short-axis technique was applied. In method A the catheter was advanced beyond the needle tip with the integral stylet extending along its entire length; in method B the catheter was advanced after its integral stylet was retracted by 6 cm, thus providing flexibility to the catheter's distal end. Additionally, to assess the procedural effectiveness of method B coiling technique, a pilot study was conducted examining 25 perineural catheters coiled underneath the sciatic nerve in trauma-orthopaedic patients to document any catheter tip displacement from their initial position (for 36 hours postoperatively).
In the simulation study, method B led to a significantly higher percentage (18/20:90%) of coiled catheters than method A (3/20:15%). Two coiled catheters of method B were found kinked/obstructed. In our patients, after catheter insertion, the distal end of 2/25 (8%) coiled catheters was obstructed. One perineural catheter was dislodged. For the remaining 22 (88%) catheters, ultrasound imaging demonstrated that local anaesthetic infusion made contact with the sciatic nerve, indicating no displacement of the catheter's distal end postoperatively.
Regular straight perineural catheters can be coiled if their integral stylet is partially retracted. This coiling method offers extra catheter length adjacent to the nerve structure which potentially mitigates catheter tip displacement.
clinicaltrials.gov, registration No: NCT06568510, 23/08/2024, registration URL: https://clinicaltrials.gov/study/NCT06568510?intr=coiling%20of%20echogenic%20sciatic%20nerve&rank=1#study-overview.
背景/目的：我们在超声（US）区域麻醉模拟器中研究了一种便于将普通直导管（带一体式导丝）盘绕在坐骨神经后方的技术，然后将我们的研究结果应用于一系列骨科创伤患者。
我们在坐骨神经阻滞蓝色幻影模拟器中对两种神经周围导管推进方法进行了随机研究。在实时超声成像下评估两组各20根导管（方法A和方法B）。采用针平面/神经短轴技术。在方法A中，导管随着一体式导丝沿其全长延伸而推进到针尖之外；在方法B中，导管在其一体式导丝缩回6 cm后推进，从而使导管远端具有灵活性。此外，为了评估方法B盘绕技术的操作效果，进行了一项初步研究，检查25根在创伤骨科患者坐骨神经下方盘绕的神经周围导管，以记录导管尖端相对于其初始位置的任何移位情况（术后36小时）。
在模拟研究中，方法B导致盘绕导管的百分比（18/20:90%）显著高于方法A（3/20:15%）。发现方法B的两根盘绕导管出现扭结/阻塞。在我们的患者中，导管插入后，2/25（8%）根盘绕导管的远端出现阻塞。一根神经周围导管移位。对于其余22根（88%）导管，超声成像显示局部麻醉药注入与坐骨神经接触，表明术后导管远端无移位。
如果普通直神经周围导管的一体式导丝部分缩回，则可以盘绕。这种盘绕方法在神经结构附近提供了额外的导管长度，这可能减轻导管尖端移位。
clinicaltrials.gov，注册号：NCT06568510，2024年8月23日，注册网址：https://clinicaltrials.gov/study/NCT06568510?intr=coiling%20of%20echogenic%20sciatic%20nerve&rank=1#study-overview 。
