A Subgluteal Approach to the Sciatic Nerve in Adults at 10 cm From the Midline

Franco, Carlo D.; Choksi, Nandak; Rahman, Abed; Voronov, Gennadiy; Almachnouk, Mohammad H.

doi:10.1016/j.rapm.2006.02.004

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…Specifically, after regression analysis, females of the same age, weight, and height have an expected nerve division that is 0.40 cm deeper than males. Adipose tissue appears to be a more significant regulator than skeletal tissue with regard to skin-nerve depth [9]. This is reflected in our data, where intuitively, greater weight increased skin-nerve depth.…”

Section: Discussionsupporting

confidence: 66%

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

Chiang¹,

Dangerfield²,

Asay³

et al. 2013

OJAnes

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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.

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Section: Discussionsupporting

confidence: 66%

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

Chiang¹,

Dangerfield²,

Asay³

et al. 2013

OJAnes

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“…This approach includes identifying the popliteal blood vessels in the popliteal crease first, and then locating the sciatic nerve by moving the probe cephalad along the tibial nerve. Our data, obtained in lean, healthy, and relatively young volunteers, suggested that starting about 5 cm distal to the subgluteal fold, possibly 10 cm lateral from the midline (i.e., the intergluteal sulcus) as proposed by Franco et al (9), might be for this population, an alternative useful approach for ultrasonographic identification of the sciatic nerve via a posterior approach. Interestingly, according to the results of this study, the optimal point for the sciatic nerve block would be very close to that recommended by Di Benedetto et al (8).…”

Section: Discussionsupporting

confidence: 55%

“…Mean depths of the sciatic nerve at the subgluteal fold between 4.5 and 8.5 cm found by sciatic nerve stimulation have been reported (8–10). In our volunteers, the ultrasonographically measured mean depth of the sciatic nerve at the subgluteal fold was only 3.2 cm.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography

Bruhn

Geffen

Gielen

et al. 2008

Acta Anaesthesiol Scand

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“…Various approaches to the sciatic nerve are utilized. For femur fractures, more proximal approaches, such as the classic Labat technique or the subgluteal approach [Di Benedetto et al, 2002;Franco et al, 2006], are appropriate. For leg and ankle fractures, a more distal approach, such as a popliteal catheter, may be more suitable, as sparing of the hamstring musculature is important for ambulation.…”

Section: Femur Fracturesmentioning

confidence: 99%

Regional Anesthesia for the Trauma Patient

Lucas¹,

Le-Wendling²,

Enneking³

2012

Pain Management - Current Issues and Opinions

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A Subgluteal Approach to the Sciatic Nerve in Adults at 10 cm From the Midline

Abstract: This report shows that a sciatic nerve block can be performed in the subgluteal area at 10 cm from the midline in adult patients of both sexes and various sizes. Anesthesia of the posterior thigh is not consistently accomplished with this approach.

Cited by 8 publications

References 10 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

Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography

Regional Anesthesia for the Trauma Patient

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