Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach

Abstract

Background:Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches. Aims:To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate. Settings and Design:After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45-75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation. Methods:Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28). femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking for rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn't require shifting to GA. Result:Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach. Conclusion:Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate

Parasacral ischial plane block for lower limb wound debridement surgeries – A case series

“…Hussien et al . [ 4 ] in their study comparing the US-guided sciatic nerve block through popliteal and subgluteal approach found that the time taken to perform the block was 11 ± 4 minutes in the popliteal approach and 18.15 ± 4.7 minutes in the subgluteal approach.…”

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

“…Ultrasound has the advantage of providing satisfactory intraoperative anesthesia results similar to prolonged postoperative analgesia that can last approximately 20 hours. 3 In this case reported, the patient required amputation of the limb above the knee due to of death of the lower limb in the right cruris region. Patients also require continuous anticoagulant treatment for high-risk thrombo-embolism and poor cardiovascular condition after the recent stroke.…”

“…Sciatic nerve block creates anesthesia to the skin on the back of the thigh, hamstrings, biceps, parts of the hip and knee joints, and the entire leg below the knee, except for the skin on the medial side of the bottom of the lower limb. 3,4 The femoral neuron fiber is the largest distributary of the lumbar plexus. This nerve is formed by the dorsal portion of the anterior branch of the L2-L4 spinal nerves.…”

“…Sciatic and femoral nerve blocks can block most of the foot. 3,4 Recently ultrasound-guided regional nerve blocks have become approved and are often used for anesthesia and postoperative pain control. Ultrasound has the advantage of providing satisfactory intraoperative anesthesia results similar to prolonged postoperative analgesia that can last approximately 20 hours.…”

Ultrasound guided sciatic nerve blockade – subgluteal and popliteal approaches

“…The subgluteal approach to the sciatic nerve confers an increased motor blockade compared to its popliteal counterpart, and more extensive analgesia [14,15]. Due to its deeper location at this point, the proximal sciatic nerve may be more difficult to visualise.…”