title: Tibial and common fibular nerve block in the popliteal fossa with single puncture using percutaneous nerve stimulator: anatomical considerations and ultrasound description.
abstract: OBJECTIVE
  Techniques of peripheral nerve block have gained popularity over the last two decades becoming a growing anesthetic option for limb surgeries. This study proposes a technical approach of the tibial and common fibular nerves in the popliteal fossa with single puncture using percutaneous nerve stimulator, considering the correlation with an anatomical and ultrasound study.
  
  
  METHODS
  This prospective, observational, randomized study was performed with 28 patients scheduled for foot surgeries. After localizing the tibial and common fibular nerves through percutaneous stimulation, the puncture was performed at the point of tibial nerve stimulation with a 5-cm needle (B.Braun, Stimuplex 50), and 10 mL of levobupivacaine were injected. The needle was pulled back and redirected to the point of common fibular nerve stimulation looking for the corresponding motor response, and 10 mL of the local anesthetic were injected. Imaging study of the popliteal region was performed by ultrasound to correlate the anatomy with the technique used.
  
  
  RESULTS
  Adequate anesthesia was obtained in all cases. The mean time to localize the tibial and common fibular nerves suing the percutaneous stimulator was 57.1 and 32.8 seconds, respectively, and with the nerve stimulator it was 2.22 and 1.79 minutes, respectively. The mean depth of the needle into the tibial nerve was 10.7 mm.
  
  
  CONCLUSIONS
  The approach for tibial and common fibular nerves with single puncture in the popliteal fossa using peripheral nerve stimulator is a good option for anesthesia and analgesia for foot surgeries.
authors.affiliation: Universidade Federal de Uberlândia, Brazil. olirangelbr@yahoo.com.br
authors.forename: Viviane de Oliveira
authors.initials: Vde O
authors.lastname: Rangel
authors.forename: Raphael de Almeida
authors.initials: Rde A
authors.lastname: Carvalho
authors.forename: Beatriz Lemos da Silva
authors.initials: BL
authors.lastname: Mandim
authors.forename: Rodrigo Rodrigues
authors.initials: RR
authors.lastname: Alves
authors.forename: Roberto Araújo
authors.initials: RA
authors.lastname: Ruzi
authors.forename: Neuber Martins
authors.initials: NM
authors.lastname: da Fonseca
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010543:Peroneal Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011677:Punctures; D013979:Tibial Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D004561:Transcutaneous Electric Nerve Stimulation; D014463:Ultrasonography