Anatomical basis for sciatic nerve block at the knee level

Barbosa, Fabiano Timbó; Barbosa, Tatiana Rosa Bezerra Wanderley; Cunha, Rafael Martins da; Rodrigues, Amanda Karine Barros Ferreira; Ramos, Fernando Wagner da Silva; Sousa‐Rodrigues, Célio Fernando de

doi:10.1016/j.bjane.2014.03.010

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…The variability in SN division and the exact location as to where the nerve branch into common fibular and TNs has been reported as an important factor in the performance of the blockade of nerves in the popliteal region (Vloka et al, ; Suresh et al, ; Barbosa et al, ). Corroborating the findings of earlier studies, as summarized in Table , we have found a wide variation in the bifurcation level of the SN (Fig.…”

Section: Discussionmentioning

confidence: 99%

A computed tomography and magnetic resonance imaging study of the variations of the sciatic nerve branches of the pediatric knee: Implications for peripheral nerve blockade

et al. 2019

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In pediatric patients, peripheral anesthetic blockade of the sciatic nerve is useful for postoperative pain relief after orthopedic procedures of the lower limb. The identification of the sciatic and its branches relative to the surrounding anatomical structures of the knee significantly contribute to the successful nerve blockade. However, reports have demonstrated complications arising from the inadequate and inconsistent understanding of the anatomy of the nerves in the knee region. In addition, the paucity of information regarding the location of the nerves of the knee throughout the pediatric development needs to be addressed in order for peripheral nerve blockades to become more readily used among the pediatric population. This clinical imaging study therefore aimed to document and analyze the relative morphometric relationship of the nerves in the knee region throughout the different stages of pediatric development. The locations of the sciatic, tibial, and common fibular nerves were measured in relation to relevant anatomical structures in 142 pediatric magnetic resonance imaging and computed tomography. A strong correlation was found between age and the distance from the common fibular nerve to the semitendinosus muscle, and thus can be used to predict stature. Significant differences were found between males and females, specifically after puberty, suggesting that sexual dimorphism emerges more distinctively at puberty. In order to predict the location of the nerves at the popliteal fossa, a regression formula using the patient's age and bicondylar width was created. These finding may have significant implications for popliteal approach of the sciatic nerve blockade in pediatric patients. Clin. Anat. 32:836-850, 2019.

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Section: Discussionmentioning

confidence: 99%

A computed tomography and magnetic resonance imaging study of the variations of the sciatic nerve branches of the pediatric knee: Implications for peripheral nerve blockade

et al. 2019

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“…The preferred site for PNB is 5–7 cm proximal to the popliteal fossa, but previous studies have suggested that anatomical variations may predispose to nerve injury in popliteal blocks, and it stands to reason that ultrasound‐guided nerve blocks may help prevent injury to the nerve, especially considering the variable anatomy . Judicious use of sedation is also recommended during these procedures .…”

Section: Discussionmentioning

confidence: 99%

Sciatic neuropathy due to popliteal fossa nerve block

et al. 2017

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“…Cadaver studies have confirmed the location of this bifurcation to range from approximately 0-11 cm proximal to popliteal crease, most commonly 5-7 cm above the crease. 2,3 Using ultrasound guidance, practitioners can target a precise location along the sciatic nerve relative to the sciatic bifurcation for deposition of local anesthetic. 4-6 …”

Section: Introductionmentioning

confidence: 99%

Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial

Monahan

Madison

Loland

et al. 2016

Anesthesia &Amp; Analgesia

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Background Multiple studies have demonstrated that, for single-injection popliteal sciatic nerve blocks, block characteristics are dependent upon local anesthetic injection relative to the sciatic nerve bifurcation. In contrast, this relationship remains unexamined for continuous popliteal sciatic nerve blocks. We therefore tested the hypothesis that postoperative analgesia is improved with the perineural catheter tip at the level of the bifurcation compared to 5 cm proximal to the bifurcation. Methods Preoperatively, subjects having moderately painful foot or ankle surgery were randomly assigned to receive an ultrasound-guided subepimyseal perineural catheter inserted either at or 5 cm proximal to the sciatic nerve bifurcation. Subjects received a single injection of mepivacaine 1.5% either via the insertion needle preoperatively or the perineural catheter postoperatively, followed by an infusion of ropivacaine 0.2% (6 mL/h basal, 4 mL bolus, 30 min lockout) for the study duration. The primary end point was the average pain measured on a numeric rating scale (NRS; 0-10) in the 3 hours prior to a data collection telephone call the morning after surgery. Results The average NRS of subjects with a catheter inserted at the sciatic nerve bifurcation (n=64) was a median [10th, 25th-75th, 90th quartiles] of 3.0 [0.0, 2.4-5.0, 7.0] versus 2.0 [0.0, 1.0-4.0, 5.0] for subjects with a catheter inserted proximal to the bifurcation (n=64; P=0.008). Similarly, maximum pain scores were higher in the group at the bifurcation: 6.0 [3.0, 4.4-8.0, 9.0] versus 5.0 [0.0, 3.0-8.0, 10.0] (P=0.019). Differences between the groups for catheter insertion time, opioid rescue dose, degree of numbness in the foot/toes, catheter dislodgement, and fluid leakage did not reach statistical significance. Conclusions For continuous popliteal sciatic nerve blocks, a catheter inserted 5 cm proximal to the sciatic nerve bifurcation provides superior postoperative analgesia in subjects having moderately painful foot or ankle surgery compared with catheters located at the bifurcation. This is in marked contrast with single-injection popliteal sciatic nerve blocks for which benefits are afforded to local anesthetic injection distal, rather than proximal, to the bifurcation.

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Anatomical basis for sciatic nerve block at the knee level

Abstract: The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%.

Cited by 4 publications

References 8 publications

A computed tomography and magnetic resonance imaging study of the variations of the sciatic nerve branches of the pediatric knee: Implications for peripheral nerve blockade

A computed tomography and magnetic resonance imaging study of the variations of the sciatic nerve branches of the pediatric knee: Implications for peripheral nerve blockade

Sciatic neuropathy due to popliteal fossa nerve block

Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial

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