The Clinical And Functional Outcomes Of Ultrasound-guided Anesthetic Blocks Of Tibial Nerve To Treat Ankle Spasticity In Patients With Hemiplegic Stroke

Objective: Locally acting treatments for spasticity such as nerve and motor point blocks have advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. Peripheral anesthetic blocks can transient block muscle and nerve input and output. The aim of this study was to evaluate the motor function before and after tibial nerve block. Using ultrasound guidance for needle placement , blocks were performed with 0.25% bupivacaine in subjects with spastic hemiplegia having Modified Ashworth scale scores for their triceps greater than 2, and Brunnstrom scores for their leg greater than 2.The goal was to analyze functional improvement and quantify outcomes and attempt to document adverse effects.Method: Twenty-four patients with first stroke were randomly allocated to one of two groups : therapeutic group and control group. A nonsurgical minimally invasive technique uses nerve blockade of bupivacaine to provide nerve blockade of the tibial nerve. Because of the anatomic location of tibial nerve, the technique uses ultrasound guidance for needle placement. Outcome measures (Modified Ashworth scale, Brunnstrom Stage, Passive Range of Motion, and Gait Assessment) were applied at 1 week before and after treatment.Results: No postblock complications were observed. Ashworth scores of triceps of subjects decreased significantly after treatment and therapeutic group showed greater response than control group (P<0.05). Subjects in the therapeutic group performed better on Brunnstrom stages and passive range of motion, and these improvement were statistically significant (P<0.01), and showed greater response than control group(P<0.05). Gait analysis demonstrated a statistically significant increase on the subjects who received tibial nerve block, with stride speed, stride length, cadence and stride width also increased. Comparing the same parameters between baseline and after treatment, ankle angle during gait significantly improved (P<0.01 or P<0.05). Subjects in control group also showed some improvement,Conclusion: The results of the present study emphasize the effect of tibial nerve block for the motor rehabilitation of the centrally spasticity. Nerve block improved walking and reduced spasticity at the ankles on the spastic hemiplegic side. Combined with rehabilitation, it improve the subjects'motor ability and providing a new way in treating spasticity after upper neuron lesion.