title: Ultrasound-guided medial mid-thigh approach to sciatic nerve block with a patient in a supine position.
abstract: We report the use of a 'medial mid-thigh approach (medial approach),' a new approach for performing ultrasound-guided sciatic nerve blockade (SNB) with patients in a supine position. Fifty-four patients undergoing knee surgery under general anesthesia and a combined femoral nerve block (FNB) and SNB were included in the study. After FNB, an ultrasound-guided medial approach was used to perform the SNB. The patient was placed in a supine position, and the hip and knee joints were flexed with the leg rotating externally. A linear ultrasound transducer was positioned perpendicular to the skin at the level of the upper mid-thigh. The sciatic nerve was identified in all patients using ultrasound imaging, and the distance to the nerve was 3.0-5.5 cm. A combined ultrasound- and nerve stimulator-guided SNB was then performed, and 0.375% ropivacaine was administered. The block was successful in all patients, and the mean duration of the sensory and motor blockade was 11.9 and 8.2 h, respectively. In this study, the medial approach was highly successful and easy to perform. As performing a simultaneous FNB and SNB with patients in a supine position has several potential advantages, future studies should compare this approach with other more proximal approaches for performing SNB.
authors.affiliation: Department of Anesthesiology, Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8642, Japan. yosaka@insti.kitasato-u.ac.jp
authors.forename: Yoshimune
authors.initials: Y
authors.lastname: Osaka
authors.forename: Masanori
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nagatsuka
authors.forename: Sakurako
authors.initials: S
authors.lastname: Miwa
mesh_terms: D000368:Aged; D000577:Amides / Q000494:pharmacology; D000768:Anesthesia, General / Q000379:methods; D005267:Femoral Nerve / Q000000981:diagnostic imaging*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D035002:Lower Extremity / Q000000981:diagnostic imaging*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D000077212:Ropivacaine; D012584:Sciatic Nerve / Q000000981:diagnostic imaging*; D016683:Supine Position; D014463:Ultrasonography
chemical_list: D000577:Amides; D000077212:Ropivacaine