P Pu ur rp po os se e: : Lower limb anesthesia (LLA) requires the combination of, at least, three-in-one and sciatic nerve (SCN) blocks. Anterior approaches are easier to perform with minimal discomfort in supine patients, specially for traumatology. Feasibility of a single needle entry combined approach is reported.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : The combined landmark was applied in 119 ASA I and II patients (32-68 yr) scheduled for surgery below the knee. Needle (nerve stimulation applied through a single 150-mm long b-bevelled insulated needle) was inserted at the midpoint between the two classical approaches. Thirty and 15 mL of 0.5% ropivacaine were injected close to the femoral and the SCN, respectively. During the following 45 min, the extent of sensory block and knee and ankle motor block were assessed.

P Pu ur rp po os se e: : Several techniques of tibial nerve (TN) block have been described but require mobilization of the patient. We describe a new landmark, along the internal tibial shaft edge at the midleg level, that allows to block the TN and to insert a catheter with the patient lying supine.M Me et th ho od ds s: : 241 ASA physical status I to III awake, supine patients were studied prospectively. Cutaneous projections of the internal tibial condyle and the internal malleolus were marked and the needle was inserted 45° cephalad in an antero-posterior plane, midway on the line between those two points, 1 cm posterior to the tibial shaft's internal edge. The catheter was introduced in the peri-nervous space using nerve stimulation (< 0.5 mA) on both the Tuohy needle and catheter. Ten millilitres of 2% lidocaine were injected through the catheter. Cutaneous and dermatomal sensory blockade were assessed using cold and pinprick tests while motor block was assessed using a modified Bromage scale. Satisfaction and analgesia scores were noted after surgery for 48 hr. Adverse events were recorded. R Re es su ul lt ts s: : The TN was always blocked, matching the distal L5 cutaneous nerve supply. Blood reflux was present in five patients (needle or catheter). No additional adverse events were noted. During the initial postoperative 48 hr, 0.2% ropivacaine was infused through the catheter (5 mL·hr -1 ) which always provided effective pain relief.C Co on nc cl lu us si io on n: : The midleg technique of TN anesthesia and catheter insertion allows patients to remain in the supine position and results in a high rate of homogeneous anesthesia, a low incidence of side effects and effective continuous analgesia. HE tibial nerve (TN) block is now well accepted for the provision of anesthesia or postoperative analgesia for forefoot surgery in adult patients. 1-3 Several approaches have been described either proximally in the popliteal region 4-9 or at the ankle 2,3 but are associated with an incomplete block. A novel antero-internal landmark for TN block was developed at the midleg level to combine firstly, ease of performance in a supine patient, secondly, a high enough approach to block the whole TN, and thirdly, to allow insertion of a catheter for postoperative analgesia. This new stimulation guided approach to the TN was evaluated Objectif