A New Single-Position Supine Approach to Sciatic-Femoral Nerve Block

Abstract

To overcome the disadvantages of other methods, the authors have devised a procedure for below-the-knee operations, involving a new technic of sciatic-femoral nerve block. The technic has so far been successful without use of adjuvant agents in 90 percent of over 100 patients so handled.

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

“…There are a variety of approaches to the sciatic nerve block and their success rate is widely variable, ranging from 33% to 95%. [79][80][81][82] Gaston Labat 83 first described, at the beginning of the 20th century, the sciatic nerve block that is now referred to as the Classic Approach of Labat. This approach is based on the bony relationship of the posterior superior iliac spine and the greater trochanter with the patient positioned in a modified Sims position.…”

“…Raj et al 80 described a supine approach to the sciatic nerve in the flexed hip position, initiating the block at the midpoint between the greater trochanter of the femur and the ischial tuberosity. The positioning of the patient was thought to be advantageous compared to the classic approach of Labat by "thinning the gluteus maximus muscles, making the sciatic nerve more superficial."…”

Long current impulses may be required for nerve stimulation in patients with ischemic pain

“…5 Using the Stimuplex HNS 11 nerve stimulator (B Braun, Melsungen, Germany) and the 75 mm Stimulong Plus catheter set (Pajunk, Geisingen, Germany), no motor response could be obtained with even the longest duration impulse of 1.0 msec at 2.0 mA. However, at the 1 msec duration setting, paresthesias occurred with each impulse and the catheter threaded easily.…”

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador

“…Another limitation is the need of long needles (10 cm) to cross the femoral trigone, which may injure femoral vessels and cause hematomas. Raj et al 11 have described in 1975 a new approach with the patient in the lithotomy position, with other reference points, allowing the access to the sciatic nerve by flexing the thigh 90 degrees over the hip. This approach, however, is limited in patients with femoral neck fracture or those with knee arthritis.…”