title: Sciatic nerve catheter placement: success with using the Raj approach.
abstract: BACKGROUND
  Continuous regional analgesia has increased in popularity and is becoming standard of care for many painful surgical procedures. Various approaches of sciatic catheter insertion have been proposed, each with attributes and disadvantages. We investigated whether the Raj approach that uses a simple midpoint landmark between the ischial tuberosity and greater trochanter will facilitate sciatic catheter placement.
  
  
  METHODS
  After informed consent, 20 patients were recruited to receive sciatic catheter placement using the Raj approach. An insulated Tuohy needle was inserted perpendicular to skin at the midpoint of a line between the ischial tuberosity and greater trochanter. After sciatic nerve stimulation, a catheter was inserted 2-4 cm past the end of the needle and secured. The catheters were then incrementally injected with 30 mL of 1.5% mepivacaine. Twenty minutes after local anesthetic injection, sensory block was assessed using cold and pinprick tests, whereas motor block was assessed using a modified Bromage score. Complications and side effects were recorded.
  
  
  RESULTS
  In all instances, blocks were easy to perform and were successful. No major side effects or complications were noted.
  
  
  CONCLUSIONS
  Use of a simple landmark between easily identifiable bony structures enhances the simplicity and placement of a sciatic nerve catheter and is recommended for use in clinical practice.
authors.affiliation: Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA. robards.christopher@mayo.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Robards
authors.forename: R Doris
authors.initials: RD
authors.lastname: Wang
authors.forename: Steven
authors.initials: S
authors.lastname: Clendenen
authors.forename: Beth
authors.initials: B
authors.lastname: Ladlie
authors.forename: Roy
authors.initials: R
authors.lastname: Greengrass
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee; D002404:Catheterization; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009339:Needles; D009407:Nerve Block / Q000295:instrumentation* / Q000379:methods*; D012584:Sciatic Nerve / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local