Sciatic nerve block in the popliteal fossa: description of a new medial approach.
OBJECTIVE
Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level.


METHODS
After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected.


RESULTS
Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30 degrees in all directions). The leg was flexed at 130 degrees . In this position, above the adductor tubercle, a depression known as Jobert's fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4-8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4-9 cm). Mean time to perform the block was 100 sec (range 55-165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5-60 min) inside the common peroneal nerve area and 43 min (range 15-75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed.


CONCLUSIONS
We describe a new medial approach to the sciatic nerve in the popliteal fossa. More studies will be required to demonstrate the technique is effective and safe.
Guntz
Emmanuel
E
Departments of Anesthesiology, Université Libre de Bruxelles, C.H.U Saint-Pierre, Brussels, Belgium. eguntz@ulb.ac.be <eguntz@ulb.ac.be>
Herman
Pierre
P
Debizet
Eric
E
Delhaye
Damien
D
Coulic
Very
V
Sosnowski
Maurice
M
D000322:Adrenergic Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D002102:Cadaver; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012584:Sciatic Nerve / Q000033:anatomy & histology; D012684:Sensory Thresholds; D016683:Supine Position; D013848:Thigh / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
D000322:Adrenergic Agonists; D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine