Nerve stimulator-assisted sciatic nerve block for painful procedures in the ED.

OBJECTIVE

Emergency physicians must frequently perform painful procedures on an urgent basis. These are most commonly performed using procedural sedation techniques involving parenteral sedatives and/or analgesics. Popliteal block of the sciatic nerve is a proven and safe technique used extensively in anesthesiology practice for distal lower extremity analgesia. This technique offers the advantage of relative cardiopulmonary safety, dense and prolonged analgesia, and maintenance of normal airway reflexes in patients with increased aspiration risks. The objective of this study was to explore the usefulness of sciatic nerve block in the popliteal fossa in the emergency department (ED) setting.

METHODS

We performed a retrospective analysis of all ED popliteal nerve block cases at our institution from April 2009 to April 2010. Sixteen cases were found where popliteal block was used for pain management during procedures of the leg, ankle, and foot, including fracture reduction, splinting, irrigation, and debridement. Procedural success was defined as successful completion of the technique without the need for additional procedural sedatives, patient satisfaction, and adequate postprocedural analgesia.

RESULTS

A high degree of satisfaction was seen in our patient population, and all procedures were successfully completed. Tibial nerve rather than common peroneal nerve stimulation correlated with success of the block. Postprocedural analgesia was excellent in all cases and predictably lasted 90 to 120 minutes.

CONCLUSIONS

Although limited by small numbers and its retrospective nature, this review of popliteal nerve block for painful lower extremity procedures in the ED suggests that this technique may be an attractive alternative in selected cases to parenteral procedural sedation.