A Randomized Comparison of a Modified Intertendinous and Classic Posterior Approach to Popliteal Sciatic Nerve Block

Nader, Antoun; Kendall, Mark C.; Candido, Kenneth D.; Benzon, Hubert A.; McCarthy, Robert J.

doi:10.1213/ane.0b013e31818c9452

Cited by 13 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nader et al compared nerve stimulator-guided popliteal sciatic nerve block with a classic approach performed 7 -8 cm to a modified intertendinous approach performed 12 -14 cm above the popliteal crease. They found complete block achieved in 39 of 54 (79.9%) patients in the classic posterior group compared to 44 of 55 (81.5%) patients in the modified intertendinous group [3].…”

Section: Discussionmentioning

confidence: 96%

“…The textbook posterior approach to the distal sciatic nerve is performed approximately inserting a needle 7 -8 cm proximal to the crease formed in the popliteal fossa when the knee is flexed 90 degrees. The technique does not factor in patient characteristics and anatomical variations of the nerve [3]. An anatomical variation in the division of the sciatic nerve is seen as a possible cause for incomplete blocks.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

Chiang¹,

Dangerfield²,

Asay³

et al. 2013

OJAnes

View full text Add to dashboard Cite

The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx ® with 38-mm broadband linear array, 13 -6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

Chiang¹,

Dangerfield²,

Asay³

et al. 2013

OJAnes

View full text Add to dashboard Cite

show abstract

“…Such injection does not take anatomical variations of the sciatic nerve (SN) into account. Therefore, incomplete block of the sciatic nerve in the popliteal fossa cannot be disregarded (Saleh et al;Nader et al, 2009;Vloka et al, 2001). Accordingly, an anatomical study of the location of the SN in the popliteal fossa is required.…”

Section: Introductionmentioning

confidence: 99%

The Effective Injection Point of the Popliteal Region: A Cadaver Dissection Without Removing the Perineurium

Sohn

Lee

et al. 2015

Int. J. Morphol.

View full text Add to dashboard Cite

SUMMARY:The aim of this study was to determine the in-depth anatomical location of the neurovascular structures important for nerve block. Forty fresh specimens from 22 adult Korean cadavers were used for this study. The average angle and depth of the bifurcation point of the sciatic nerve (BC) was 18.7±3.6° and 20.6±7.1 mm, respectively. The point where the nerve branching point out for the muscles on the posterior compartment of leg were expressed in percentage distance relative to the vertical distance from popliteal crease to BC. The medial and lateral sural cutaneous nerve for 129.0% and 116.4%, medial and lateral head of gastrocnemius for 137.2% and 141.9%, the soleus for 179.5%, the deep compartment of leg for 167.0%. Our results provide detailed anatomical information to guide optimal nerve block.

show abstract

“…On the other hand, the intertendinous approach involves injection at the midpoint between the tendons of the biceps femoris and the semitendinosus. Some studies have concluded that the intertendinous approach is the more useful of the two Nader et al, 2009). These two approaches to injections at the sciatic nerve are referred to collectively as prebifurcation blocks.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, incomplete block of the sciatic nerve in the popliteal fossa cannot be disregarded (Saleh et al;Nader et al;Vloka et al, 2001). Accordingly, an anatomical study is required on the location of the SN in the popliteal fossa and popliteal crease.…”

Section: Introductionmentioning

confidence: 99%

The Effective Injection Zone at the Popliteal Crease for Tibial and Common Peroneal Nerve Blocks and its Relation with the Origin Point of the Medial and Lateral Sural Cutaneous Nerves

et al. 2014

View full text Add to dashboard Cite

SUMMARY:A popliteal nerve block may be used to provide anesthesia and extended analgesia of the lower extremity, to ameliorate severe and long lasting postoperative pain. The aim of this study was to elucidate the anatomical location of tibial (TN) and common peroneal (CPN) nerves in the popliteal crease for effective nerve block. Fifty fresh specimens from 27 adult Chinese cadavers (16 males and 11 females, age range from 35 to 87 years) were investigated. Twenty-two cadavers were used to identify nerve locations and 5 cadavers were used to determine the depths of nerves in cross section. TN was found to be located at 50% from the most lateral point of the popliteal crease at 1.4 cm deep to the surface. In 20% of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26.0% from the most lateral point of the popliteal crease and at 0.7 cm deep to the surface. Furthermore, in 6.0% of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. This study suggests that the TN and CPN leave the sciatic nerve at variable distances from the popliteal crease. However, we believe that the results of the present study about the location of TN and CPN at the popliteal crease offer a good guide to optimal nerve block.

show abstract

A Randomized Comparison of a Modified Intertendinous and Classic Posterior Approach to Popliteal Sciatic Nerve Block

Abstract: Potential advantages of the modified intertendinous approach include more rapid onset of anesthesia with an evoked motor response of inversion compared to a classic posterior popliteal sciatic nerve block.

Cited by 13 publications

References 18 publications

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

The Effective Injection Point of the Popliteal Region: A Cadaver Dissection Without Removing the Perineurium

The Effective Injection Zone at the Popliteal Crease for Tibial and Common Peroneal Nerve Blocks and its Relation with the Origin Point of the Medial and Lateral Sural Cutaneous Nerves

Contact Info

Product

Resources

About