الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Popliteal sciatic nerve block is a safe and frequently used technique to provide anesthesia and postoperative analgesia for distal lower limbs surgery. Distal lower limbs are innervated by two terminal branches of sciatic nerve (tibial and common peroneal nerves) and saphenous nerve which is a branch of femoral nerve. Objective: Comparative study among four methods for sciatic nerve localization during performance of popliteal block to find out the method of better outcome and lesser side effects. Patients and methods: This randomized controlled study was conducted on 120 ASA physical status class I and II adult co-operative patients of both sexes who were scheduled for distal lower limb surgeries under popliteal sciatic block. These patients were divided into four equal groups according to the used method for nerve localization, the first group was paresthesia group (P group) , the second one was electrical nerve stimulation group (ES group),the third group was ultrasound group (US group) and the fourth one was combined ultrasound and electric stimulation (USES group). Number of attempts for sciatic nerve localization, patient discomfort level, block performance time, failure rate, the onset of sensory and motor nerve block, postoperative pain intensity, the time to the first request for supplemental systemic analgesia postoperatively and its total consumption and the incidence of the associated side effects were recorded in each group. Results: Statistically, it was found no significant differences between the demographic characteristics as well as the duration of surgery of both groups. The number of patients who needed one or two attempts for sciatic nerve localization was significantly higher and the number of those who needed three or more attempts was significantly lower in US and USES groups than in P and ES groups. The failure rate to achieve successful nerve block was significantly lower in ENS and P groups. The onsets of complete sensory and motor blocks in US and USES groups were highly significant shorter than that in P and ES groups. The postoperative pain intensity levels at 4 and 6 hours were significantly lower in US and USES groups than in P and ES groups but no significant difference between both groups at other times of measurements. The time to the first request for supplemental analgesia was significantly longer and its total consumption was significantly less in US and USES groups than in P and ES groups. The incidence of postoperative neuropathy was significantly lower in US and USES groups than in P and ES groups while, there was no significant difference in incidence of the vascular puncture of all groups. Local anesthetic systemic toxicity was not detected in any group. In conclusion, Ultrasound and Combined ultrasound and electric nerve stimulation is superior to paresthesia and electric stimulation for sciatic nerve localization during performance of popliteal block because it is associated with lower number of attempts for nerve localization, lesser patient discomfort, shorter block performance time, lower failure rate, shorter onsets of sensory and motor block, lesser postoperative pain, longer time for the first request of postoperative supplemental analgesia and the need to lesser amount of analgesics and lower incidence of the associated side effects.