Sciatic nerve blockade in the supine position: a novel approach

Abstract

P Pu ur rp po os se e: : Sciatic nerve block is useful for surgery below the knee both intra-and postoperatively. Several techniques to insert a catheter at the knee level or higher have been described but need mobilization (lateral decubitus) of the patient. We describe novel landmarks, using a high lateral approach, to block the sciatic nerve without moving the patient.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : One hundred seven ASA I, II and III ASA patients scheduled for major foot or ankle surgery were studied prospectively. With patients awake and lying in the supine position, the catheter was introduced along novel landmarks in the peri-nervous adipose space using specifically designed material and nerve stimulation (< 0.5 mA). After a negative test dose (1% lidocaine with 1/200.000 epinephrine), 10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine were injected. Thirty minutes after performance of the block, the cutaneous and dermatomal sensory blockade were assessed using cold and pinprick tests while motor block was assessed using a modified Bromage scale. Complications and incidents were recorded. The tibial and superficial peroneal nerve were always blocked, while the deep peroneal and posterofemoral cutaneous nerves were blocked in only 97% and 83% of the patients, respectively. Anesthesia, was always present in the dermatome L5 and in the S1 dermatome in 98% of the patients. No major incidents or complications were noted. Three catheters could not be inserted and the anesthestic solution was injected through the needle.

Lateral Supratrochanteric Approach to Sciatic and Femoral Nerve Blocks in Children: A Feasibility Study

“…Other lateral approaches to the sciatic nerve below the greater trochanter level were described by Guardini et al [ 19 ], Morrow [ 20 ], and Pandin et al [ 21 ]. They used the greater trochanter as the main landmark and point 1.5–3 cm distal to the greater trochanter as the needle insertion site.…”

Proximal lateral approach to ultrasound-guided sciatic nerve block: a volunteer and cadaveric study

“…In 1985, Guardini described a nerve stimulation-guided approach with an insertion point for the block needle 3 cm caudal from the inferior border of the greater trochanter 15. This approach was also useful for catheter insertion guided by nerve stimulation 16. A proximal lateral approach to the sciatic nerve with nerve stimulation was also mentioned in a Letter to the Editor in 2000 17.…”

Proximal lateral approach to ultrasound-guided sciatic nerve block: where is the correct injection site?

“…Additionally, we have found the anterior approach rather difficult to perform. In the literature, we found descriptions of some landmark-based proximal lateral approaches with varying insertion points of the block needle 4–6. At that time, none of these approaches had been performed with the aid of ultrasound.…”