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1. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery

Author

Edwards M, Forbes G, Berdunov V, Mihaylova B, Dias P, Thomson A, Grocott M, Mythen M, Gillies M, Phan T, Evered L, Wijeysundera D, McCluskey S, Hofer C, Abukhudair H, Szczeklik W, Hajjar L, Kahan B, Pearse R, MacDonald N, Abbott T, Martin T, Januszewska M, Niebrzegowska E, Bekele S, Pates K, Haines R, Walker S, Fowler A, Oliveira M, Whalley J, Stephens T, Amaral V, May S, Manou V, Jones T, Dunkley S, Pakats M, Griffiths B, Fernandez M, Jonas M, Bolger C, Collings N, Burnish R, Kelleher M, Dawson H, Lang A, Campbell R, Rea N, Clark S, Blunt M, Rosbergen M, Hodgson R, Wittenberg M, Filipe H, Gleeson Y, Pakou G, Szakmany T, Gunter U, Hodkinson G, Reay M, Gidda R, Allcock C, Cole A, Watts A, Gardner W, Tindall M, Anumakonda V, Agarwal N, Price T, Clark P, Thompson R, Fowler S, Gray K, McGregor A, Smith T, Wilson T, Guha A, Hodgson A, McSkeane A, Barberis L, Mohamed M, Prentice S, Saunders Z, Ratnam V, Pawa N, Sayan A, Thankachen M, Svensson M, Raj A, Ahmad N, Ivermee C, Cashman J, Smee E, Kanapeckaite L, Corcoran P, Fitzgerald E, Peyton P, Buckley A, Baulch S, Claxton G, Harris S, Sidiropolous S, de Almeida J, Simoes C, Galas F, Camara L, Malbouisson L, Soares S, Fernandes C, Joaquim E, Stefani L, Falcao L, Salgado M, Guimaraes G, Gomes M, Lineburger E, Navarro L, Salles L, Azi L, Prado R, Benedetti R, de Godoy E, Bastos F, da Silva R, dos Santos W, Pazmino-Canizares J, Parotto M, Wasowicz M, Beattie S, Meineri M, Clarke H, Ladha K, Jerath A, Ayach N, Poonawala H, Sellers D, Duncan D, Carroll J, Hudson C, van Vlymen J, Jaeger M, Shelley J, Shore D, McQuaide S, Richebe P, Godin N, Gobert Q, Fortier L, Verdonck O, Sato H, Schricker T, Codere-Maruyama T, Lattermann R, Hatzakorzian R, Moore A, Sato T, Funk D, Kowalski S, Girling L, Monterola M, Fidler K, Sander M, Markmann M, Schulte D, Singer R, Koch C, Ruhrmann S, Habig L, Edinger F, Schneck E, Treskatsch S, Ertmer M, Trauzeddel R, Weyland A, Diers A, Grote T, Pabel S, Lipka A, Nannen L, Fleischer A, Wittmann M, Winkler A, Neumann C, Fingerhut M, Ehrentraut H, Guttenthaler V, Heringlake M, Brandt S, Olsson S, Schmidt C, Schemke S, Murat L, Abu Khudair H, Farhoud E, Ghidan A, Al Masri M, Abu Kwiak S, Abdel-Nabi H, Grigoras I, Ristescu I, Jitaru I, Manole M, Rusu D, Gata A, Aldecoa C, Gonzalez A, Alfonso S, Perz L, Feijoo J, Guerra Y, Herrero A, Ripolles-Melchor J, Abad-Motos A, de Pablo E, Martinez-Hurtado E, Abad-Gurumeta A, Salvachua-Fernandez R, Nozal-Mateo B, de Nadal M, Galan P, Visauta E, Peral E, Da Prat I, Suarez S, Peral C, Una-Orejon R, Caldera-Alvarez M, Fernandez-Francos S, Davila A, Ortola C, Gutierrez A, Mugarra A, Romero E, Soro M, Gracia E, Pozo N, Villafane A, Diez A, Sanchez C, Buron F, Blanco R, Duran M, Parada P, Torres M, Rivas M, Brage S, Castro A, Conde M, Pardal C, Ben M, Perez A, Sancho J, Alarcon M, Mariotti S, Marcolino I, Winter A, McGrane T, Craven D, Turnbo T, Mayo G, Campbell D, Klintworth S, Tilley A, Weinstein M, Horan A, Chowdary R, Carlon V, Balasinorwala T, Yang G, and OPTIMISE II Investigators

Published
2019

2. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery

Author

Edwards, MR, Forbes, G, MacDonald, N, Berdunov, V, Mihaylova, B, Dias, P, Thomson, A, Grocott, MPW, Mythen, MG, Gillies, MA, Sander, M, Phan, TD, Evered, L, Wijeysundera, DN, McCluskey, SA, Aldecoa, C, Ripolles-Melchor, J, Hofer, CK, Abukhudair, H, Szczeklik, W, Grigoras, I, Hajjar, LA, Kahan, BC, Pearse, RM, Abbott, T, Martin, T, Januszewska, M, Niebrzegowska, E, Bekele, S, Pates, K, Haines, R, Walker, S, Fowler, A, Oliveira, M, Whalley, J, Stephens, T, Amaral, VDS, May, S, Manou, V, Jones, T, Dunkley, S, Pakats, M-L, Griffiths, B, Fernandez, M, Edwards, M, Jonas, M, Bolger, C, Collings, N, Burnish, R, Kelleher, M, Dawson, H, Lang, A, Campbell, R, Rea, N, Clark, S, Blunt, M, Rosbergen, M, Hodgson, R, Wittenberg, M, Filipe, H, Gleeson, Y, Pakou, G, Szakmany, T, Gunter, U, Hodkinson, G, Reay, M, Gidda, R, Allcock, C, Cole, A, Watts, A, Gardner, W, Tindall, M, Anumakonda, V, Agarwal, N, Price, T, Clark, P, Thompson, R, Fowler, S, Gray, K, McGregor, A, Smith, T, Wilson, T, Guha, A, Hodgson, A, McSkeane, A, Barberis, L, Mohamed, M, Prentice, S, Saunders, Z, Ratnam, V, Pawa, N, Sayan, A, Thankachen, M, Svensson, M-L, Raj, A, Ahmad, N, Ivermee, C, Cashman, J, Smee, E, Kanapeckaite, L, Tuong, P, Corcoran, P, Fitzgerald, E, Peyton, P, Buckley, A, Baulch, S, Claxton, G, Harris, S, Sidiropolous, S, de Almeida, JP, Simoes, C, Galas, FRBG, Camara, L, Malbouisson, LMS, Soares, SD, Fernandes, CR, Joaquim, EHG, Stefani, LC, Falcao, LF, Salgado, M, Guimaraes, GN, Gomes, MDA, Lineburger, E, Navarro, L, Salles, LC, Azi, LMTDA, Prado, RG, Benedetti, RH, de Godoy, EP, Bastos, FA, da Silva, RJC, dos Santos, WF, McCluskey, S, Wijeysundera, D, Pazmino-Canizares, J, Parotto, M, Wasowicz, M, Beattie, S, Meineri, M, Clarke, H, Ladha, K, Jerath, A, Ayach, N, Poonawala, H, Sellers, D, Duncan, D, Carroll, J, Hudson, C, van Vlymen, J, Jaeger, M, Shelley, J, Shore, DD, McQuaide, S, Richebe, P, Godin, N, Gobert, Q, Fortier, LP, Verdonck, O, Sato, H, Schricker, T, Codere-Maruyama, T, Lattermann, R, Hatzakorzian, R, Moore, A, Sato, T, Funk, D, Kowalski, S, Girling, L, Monterola, M, Fidler, K, Markmann, M, Schulte, D, Singer, R, Koch, C, Ruhrmann, S, Habig, L, Edinger, F, Schneck, E, Treskatsch, S, Ertmer, M, Trauzeddel, R-F, Weyland, A, Diers, A, Grote, T, Pabel, S, Lipka, A, Nannen, L, Fleischer, A, Wittmann, M, Winkler, A, Neumann, C, Fingerhut, M-L, Ehrentraut, H, Guttenthaler, V, Heringlake, M, Brandt, S, Olsson, S, Schmidt, C, Schemke, S, Murat, L, Abu Khudair, H, Farhoud, E, Ghidan, A, Al Masri, M, Abu Kwiak, S, Abdel-Nabi, H, Ristescu, I, Jitaru, I, Manole, M, Rusu, D, Gata, A, Gonzalez, AP, Alfonso, SM, Perz, LV, Feijoo, JR, Guerra, Y, Herrero, A, Abad-Motos, A, de Pablo, EL, Martinez-Hurtado, E, Abad-Gurumeta, A, Salvachua-Fernandez, R, Nozal-Mateo, B, de Nadal, M, Galan, P, Visauta, EC, Peral, EC, Da Prat, IC, Suarez, SG, Peral, C, Una-Orejon, R, Caldera-Alvarez, MV, Fernandez-Francos, S, Davila, AS, Ortola, CF, Gutierrez, A, Mugarra, A, Romero, E, Soro, M, Gracia, E, Pozo, N, Villafane, AP, Diez, AF, Sanchez, CGM, Buron, FD, Blanco, RP, Duran, MV, Parada, PD, Torres, MB, Rivas, MC, Brage, SM, Castro, AMG, Conde, MJP, Pardal, CB, Ben, MRT, Perez, A, Sancho, JM, Alarcon, MM, Hofer, C, Mariotti, S, Marcolino, I, Winter, A, McGrane, T, Craven, D, Turnbo, T, Mayo, G, Campbell, D, Klintworth, S, Tilley, A, Weinstein, M, Horan, A, Chowdary, R, Carlon, VA, Balasinorwala, T, Yang, G, Edwards, MR, Forbes, G, MacDonald, N, Berdunov, V, Mihaylova, B, Dias, P, Thomson, A, Grocott, MPW, Mythen, MG, Gillies, MA, Sander, M, Phan, TD, Evered, L, Wijeysundera, DN, McCluskey, SA, Aldecoa, C, Ripolles-Melchor, J, Hofer, CK, Abukhudair, H, Szczeklik, W, Grigoras, I, Hajjar, LA, Kahan, BC, Pearse, RM, Abbott, T, Martin, T, Januszewska, M, Niebrzegowska, E, Bekele, S, Pates, K, Haines, R, Walker, S, Fowler, A, Oliveira, M, Whalley, J, Stephens, T, Amaral, VDS, May, S, Manou, V, Jones, T, Dunkley, S, Pakats, M-L, Griffiths, B, Fernandez, M, Edwards, M, Jonas, M, Bolger, C, Collings, N, Burnish, R, Kelleher, M, Dawson, H, Lang, A, Campbell, R, Rea, N, Clark, S, Blunt, M, Rosbergen, M, Hodgson, R, Wittenberg, M, Filipe, H, Gleeson, Y, Pakou, G, Szakmany, T, Gunter, U, Hodkinson, G, Reay, M, Gidda, R, Allcock, C, Cole, A, Watts, A, Gardner, W, Tindall, M, Anumakonda, V, Agarwal, N, Price, T, Clark, P, Thompson, R, Fowler, S, Gray, K, McGregor, A, Smith, T, Wilson, T, Guha, A, Hodgson, A, McSkeane, A, Barberis, L, Mohamed, M, Prentice, S, Saunders, Z, Ratnam, V, Pawa, N, Sayan, A, Thankachen, M, Svensson, M-L, Raj, A, Ahmad, N, Ivermee, C, Cashman, J, Smee, E, Kanapeckaite, L, Tuong, P, Corcoran, P, Fitzgerald, E, Peyton, P, Buckley, A, Baulch, S, Claxton, G, Harris, S, Sidiropolous, S, de Almeida, JP, Simoes, C, Galas, FRBG, Camara, L, Malbouisson, LMS, Soares, SD, Fernandes, CR, Joaquim, EHG, Stefani, LC, Falcao, LF, Salgado, M, Guimaraes, GN, Gomes, MDA, Lineburger, E, Navarro, L, Salles, LC, Azi, LMTDA, Prado, RG, Benedetti, RH, de Godoy, EP, Bastos, FA, da Silva, RJC, dos Santos, WF, McCluskey, S, Wijeysundera, D, Pazmino-Canizares, J, Parotto, M, Wasowicz, M, Beattie, S, Meineri, M, Clarke, H, Ladha, K, Jerath, A, Ayach, N, Poonawala, H, Sellers, D, Duncan, D, Carroll, J, Hudson, C, van Vlymen, J, Jaeger, M, Shelley, J, Shore, DD, McQuaide, S, Richebe, P, Godin, N, Gobert, Q, Fortier, LP, Verdonck, O, Sato, H, Schricker, T, Codere-Maruyama, T, Lattermann, R, Hatzakorzian, R, Moore, A, Sato, T, Funk, D, Kowalski, S, Girling, L, Monterola, M, Fidler, K, Markmann, M, Schulte, D, Singer, R, Koch, C, Ruhrmann, S, Habig, L, Edinger, F, Schneck, E, Treskatsch, S, Ertmer, M, Trauzeddel, R-F, Weyland, A, Diers, A, Grote, T, Pabel, S, Lipka, A, Nannen, L, Fleischer, A, Wittmann, M, Winkler, A, Neumann, C, Fingerhut, M-L, Ehrentraut, H, Guttenthaler, V, Heringlake, M, Brandt, S, Olsson, S, Schmidt, C, Schemke, S, Murat, L, Abu Khudair, H, Farhoud, E, Ghidan, A, Al Masri, M, Abu Kwiak, S, Abdel-Nabi, H, Ristescu, I, Jitaru, I, Manole, M, Rusu, D, Gata, A, Gonzalez, AP, Alfonso, SM, Perz, LV, Feijoo, JR, Guerra, Y, Herrero, A, Abad-Motos, A, de Pablo, EL, Martinez-Hurtado, E, Abad-Gurumeta, A, Salvachua-Fernandez, R, Nozal-Mateo, B, de Nadal, M, Galan, P, Visauta, EC, Peral, EC, Da Prat, IC, Suarez, SG, Peral, C, Una-Orejon, R, Caldera-Alvarez, MV, Fernandez-Francos, S, Davila, AS, Ortola, CF, Gutierrez, A, Mugarra, A, Romero, E, Soro, M, Gracia, E, Pozo, N, Villafane, AP, Diez, AF, Sanchez, CGM, Buron, FD, Blanco, RP, Duran, MV, Parada, PD, Torres, MB, Rivas, MC, Brage, SM, Castro, AMG, Conde, MJP, Pardal, CB, Ben, MRT, Perez, A, Sancho, JM, Alarcon, MM, Hofer, C, Mariotti, S, Marcolino, I, Winter, A, McGrane, T, Craven, D, Turnbo, T, Mayo, G, Campbell, D, Klintworth, S, Tilley, A, Weinstein, M, Horan, A, Chowdary, R, Carlon, VA, Balasinorwala, T, and Yang, G

Abstract

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.

Published
2019

5. Synthesis and antimicrobial testing of 5-fluorouracil derivatives.

Author

Patil M, Serhii K, Garzino F, Gobert Q, Giorgio S, Raimundo JM, Bolla JM, and Camplo M

Subjects
Staphylococcus aureus, Escherichia coli, Structure-Activity Relationship, Gram-Negative Bacteria, Gram-Positive Bacteria, Bacteria, Microbial Sensitivity Tests, Anti-Bacterial Agents pharmacology, Anti-Infective Agents pharmacology
Abstract

Antibiotic resistance has increased the demand for novel treatments against multidrug-resistant microorganisms. In the research literature, 5-fluorouracil (5-FU) was proposed as an alternative due to its intrinsic antibacterial property. However, given its toxicity profile at high doses, its use in antibacterial therapy is dubious. In the quest for improving the efficacy of 5-FU, the present study intends to synthesise 5-FU derivatives and assess their susceptibility and mechanism against pathogenic bacteria. It was found that the compounds having tri-hexylphosphonium substitution on both nitrogen groups of 5-FU (6a, 6b and 6c) had considerable activity against both Gram-positive and Gram-negative bacteria. Among the active compounds, those with an asymmetric linker group 6c were found to have higher antibacterial efficacy. However, no conclusive efflux inhibition activity was found. As elucidated by electron microscopy studies, these self-assembling active phosphonium-based 5-FU derivatives caused considerable septal damage and cytosolic alterations in Staphylococcus aureus cells. In Escherichia coli, these compounds triggered plasmolysis. Interestingly, the minimal inhibitory concentration (MIC) of the most potent 5-FU derivative 6c remained constant, regardless of the bacteria's resistance profile. Further analysis revealed that compound 6c generated significant alterations in membrane permeabilization and depolarization in S. aureus and E. coli cells at the MIC. Compound 6c was found to substantially impede bacterial motility, suggesting its importance in regulating bacterial pathogenicity. Additionally, the nonhaemolytic activity of 6c suggested that it could be a potential therapeutic option for treating multidrug-resistant bacterial infections., (© 2023 The Authors. Archiv der Pharmazie published by Wiley-VCH GmbH on behalf of Deutsche Pharmazeutische Gesellschaft.)

Published
2023
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7. Ultrasound evaluation of inferior vena cava compression in tilted and supine term parturients.

Author

Gagné MP, Richebé P, Loubert C, Drolet P, Gobert Q, Denault A, and Zaphiratos V

Subjects
Female, Humans, Pregnancy, Prospective Studies, Ultrasonography, Vena Cava, Inferior diagnostic imaging, Anesthesia, Spinal adverse effects, Hypotension
Abstract

Purpose: Hypotension is common following spinal anesthesia (SA) during elective Cesarean delivery (CD). Although common practice is to alleviate inferior vena cava (IVC) compression, limited evidence supports a 15° tilt for CD. We measured collapsibility of the IVC in supine and 15° left lateral tilt positions with ultrasound before and after SA and phenylephrine infusion in term parturients., Methods: Twenty term parturients scheduled for CD were recruited for this prospective study. Ultrasound measurements of the IVC were taken 1) supine before SA, 2) tilted 15° before SA, 3) supine after SA, and 4) tilted 15° after SA. A phenylephrine infusion was begun after injection of SA. The primary outcome was to evaluate the impact of position on the IVC collapsibility index (IVCCI): a measure of the difference between the maximum and minimum IVC diameter with respiration., Results: The mean (standard deviation) IVCCI (%) before SA was higher in the supine 19.5 (8.0) than in the tilted 15.0 (6.4) position (mean difference, 4.5; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). After SA, there was no significant difference between IVCCI (%) in the supine 17.8 (8.3) and tilted 14.2 (6.9) position (mean difference, 3.5; 95% CI, -0.9 to 7.9; P = 0.13). There was no correlation between the pre-spinal IVVCI measurements and the quantity of phenylephrine used during the surgery., Conclusion: The IVCCI was lower in the 15° tilt position than in the supine position, but not after SA with a phenylephrine infusion. Ultrasound imaging can help identify IVC compression., Trial Registration: www.clinicaltrials.gov (NCT03410199); registered 18 January 2018., (© 2021. Crown.)

Published
2021
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8. Face transplantation: anesthesia and other organizational considerations.

Author

Bélanger ME, Borsuk DE, Clairoux A, Fortier LP, Nguyen A, Georgescu M, Richebé P, Tanoubi I, Verdonck O, and Gobert Q

Subjects
Canada, France, Humans, Anesthesia, Facial Transplantation
Abstract

In 2005, the first facial vascularized composite allotransplant was performed in France. In May 2018, our team at Maisonneuve-Rosemont Hospital, Montreal, Quebec, had the privilege to participate in the first facial transplant in Canada. Interdisciplinary collaboration, coordination, and communication formed the cornerstone of this medical undertaking and, ultimately, its success. This report details the anesthetic and organizational considerations of our experience.

Published
2021
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10. Impact of anesthesia management during cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for the treatment of colorectal peritoneal carcinomatosis on intra- and postoperative outcomes: A systematic review protocol.

Author

Idrissi M, Espitalier F, Coveney R, Bélanger ME, Gobert Q, Sidéris L, Dubé P, Verdonck O, Fortier LP, and Richebé P

Subjects
Humans, Clinical Protocols, Patient Safety, Research Design, Systematic Reviews as Topic, Anesthesia adverse effects, Anesthesia methods, Anesthesia standards, Colorectal Neoplasms surgery, Cytoreduction Surgical Procedures methods, Hyperthermia, Induced methods, Peritoneal Neoplasms surgery
Abstract

Background: The impact of the anesthesia management during cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of colorectal peritoneal carcinomatosis (CRPC) on postoperative outcomes might be of major importance in the process of postoperative recovery. It might have a significant impact on intra- and postoperative outcomes, but the evaluation of this impact seems to be under-reported. To investigate the question whether the anesthesia management was reported in previous studies done in this population and if it had any impact on postoperative outcomes, we propose to conduct a systematic review of the published literature., Methods: For this review, we will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Medline/PubMed, Embase, EBM Reviews and the Cochrane Database of Systematic Reviews (CDSR) will be systematically consulted for eligible studies without age, gender, ethnic, and language restriction. The goal of this review will be to assess whether anesthesia monitoring, dosing, and analgesia protocols were reported in this literature on this specific procedure and whether the impact of the anesthesia management on intraoperative safety and postoperative recovery was evaluated., Results: The results of this systematic review will allow to answer the initial question: has the impact of anesthesia management on intraoperative safety and patients' postoperative recovery already been studied and reported in the past for this type of major surgery? And does anesthesia have any impact on postoperative outcomes?, Discussion: In the hypothesis that the impact of anesthesia management on patients' postoperative recovery has never been studied, or very little reported in previous studies in this type of major surgery, it would be justified to conduct a randomized controlled trial on this specific objective., Registration: This systematic review protocol was registered in PROSPERO, under the registration number CRD42019124162.

Published
2019
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12. A modified mid-femoral approach to the sciatic nerve block: a correlation between evoked motor response and sensory block.

Author

Pianezza A, Gilbert ML, Minville V, Filsinger D, Gobert Q, Guérot A, Fuzier R, and Fourcade O

Subjects
Adult, Aged, Female, Foot physiology, Foot surgery, Humans, Male, Middle Aged, Prospective Studies, Evoked Potentials, Motor physiology, Femoral Nerve physiology, Nerve Block methods, Sciatic Nerve physiology
Abstract

Background: The lateral sciatic mid-femoral block (LSMF), proved to be reliable, safe, and effective on both branches of the sciatic nerve with a single injection. However, we do not know which component of the sciatic nerve (the tibial [T] or the common peroneal [CP]) produces a better success rate when performing a LSMF with a single injection technique. In this prospective study we compared the success rate of the T motor response with the CP motor response., Methods: Ninety-five patients undergoing ankle or foot surgery were enrolled. Thirty milliliters of 0.475% ropivacaine was injected at the first evoked motor response, either T or CP, with a minimal intensity between 0.3 and 0.5 mA., Results: Seventy-two patients were included in group T and 23 in group CP. The block was considered a success when a complete sensory block of the sciatic nerve was obtained. The success rate was 90% (65) for the T response and 70% (16) for the CP response (P < 0.05). Time to perform the block (CP: 4.5 +/- 3 min vs T: 4.5 +/- 4 min; P = NS) as well as sensory and motor onset times were not significantly different between groups. No complications were observed in either group., Conclusion: We conclude that the evoked motor response of the T branch is associated with a higher success rate than a CP response using the modified LSMF block.

Published
2007
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