Abstract
Purpose
Sciatic nerve block is useful for surgery below the knee both intra- and postoperatively. Several techniques to insert a catheter at the knee level or higher have been described but need mobilization (lateral decubitus) of the patient. We describe novel landmarks, using a high lateral approach, to block the sciatic nerve without moving the patient.
Clinical features
One hundred seven ASA I, II and III ASA patients scheduled for major foot or ankle surgery were studied prospectively. With patients awake and lying in the supine position, the catheter was introduced along novel landmarks in the peri-nervous adipose space using specifically designed material and nerve stimulation (< 0.5 mA). After a negative test dose (1% lidocaine with 1/200.000 epinephrine), 10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine were injected. Thirty minutes after performance of the block, the cutaneous and dermatomal sensory blockade were assessed using cold and pinprick tests while motor block was assessed using a modified Bromage scale. Complications and incidents were recorded. The tibial and superficial peroneal nerve were always blocked, while the deep peroneal and posterofemoral cutaneous nerves were blocked in only 97% and 83% of the patients, respectively. Anesthesia, was always present in the dermatome L5 and in the S1 dermatome in 98% of the patients. No major incidents or complications were noted. Three catheters could not be inserted and the anesthestic solution was injected through the needle.
Conclusion
The lateral technique for sciatic nerve anesthesia and catheter insertion allows patients to remain in the supine position for performance of the block and catheter insertion, and results in a high rate of homogeneous anesthesia and a low incidence of side effects.
Résumé
Objectif
Plusieurs techniques de bloc du nerfsciatique avec mise en place d’un cathéter ont déjà été décrites mais elles nécessitent la mobilisation du patient. Ce rapport décrit un abord latéral haut pour bloquer le nerf sciatique sans bouger le patient et mettre en place facilement un cathéter.
Eléments cliniques
Cent sept patients, ASA I, II et III, opérés au pied ou à la cheville ont bénéficié de cette technique. Leur nerf sciatique a été repéré en décubitus dorsal en utilisant une technique de stimulation nerveuse classique selon une approche adaptée de la technique latérale classique et suivant une direction céphalique. Par un cathéter introduit par l’aiguille, la solution anesthésique (10 mL de bupivacaïne à 0,5 % et 10 mL de lidocaïne à 2 %) a été injectée après une dose test négative (lidocaïne à 1 % adrénalinée à 1/200000). Trente minutes après l’injection, les tests au froid et à la piqûre ont permis l’évaluation du bloc sensitif dans les territoires nerveux et dans les dermatomes correspondants, tandis que le bloc moteur était évalué grâce à un score de Bromage modifié. Toutes les complications et incidents potentiels ont été notés. Les nerfs tibiaux et péroniers superficiels étaient toujours bloqués alors que le péronier profond et le fémoro-cutané postérieur ne l’étaient que chez 97 % et 83 % des patients. Le dermatome L5 était toujours anesthésié alors que S1 l’était dans 98 %. Aucune complication majeure n’a été notée. Trois échecs d’insertion de cathéter ont, néanmoins, conduit à l’injection de la solution anesthésique par l’aiguille.
Conclusion
Cette technique d’anesthésie du nerfsciatique par abord latéral avec insertion d’un cathéter permet de ne pas bouger le patient et cela avec une incidence élevée d’anesthésie homogène du nerfsciatique et une faible survenue d’effets secondaires.
Article PDF
Similar content being viewed by others
References
Dalens B, Tanguy A, Vanneuville G. Sciatic nerve blocks in children: comparison of the posterior, anterior, and lateral approaches in 180 pediatric patients. Anesth Analg 1990; 70: 131–7.
Guardini R, Waldron BA, Wallace WA. Sciatic nerve block: a new lateral approach. Acta Anaesthesiol Scand 1985; 29: 515–9.
Kilpatrick AWA, Coventry DM, Todd JG. A comparison of two approaches to sciatic nerve block. Anaesthesia 1992; 47: 155–7.
Singelyn FJ, Gouverneur JMA, Gribomont BF. Popliteal sciatic nerve block aided by a nerve stimulator: a reliable technique for foot and ankle surgery. Reg Anesth 1991; 16: 278–81.
Rorie DK, Byer DE, Nelson DO, Sittipong R, Johnson KA. Assessment of block of the sciatic nerve in the popliteal fossa. Anesth Analg 1980; 59: 371–6.
Naux E, Pham-Dang C, Petitfaux F, et al. Sciatic nerve block: a new lateral mediofemoral approach. The value of its combination with a “3 in 1” block for invasive surgery of the knee (French). Ann Fr Anesth Réanim 2000; 19: 9–15.
Raj PP, Parks RI, Watson TD, Jenkins MT. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg 1975; 54: 489–94.
Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders Ed; 1978.
Beck GP. Anterior approach to sciatic nerve block. Anesthesiology 1963; 24: 222–4.
Labat G. Regional anesthesia. Its technique and clinical applications, Philadelphia: WB Saunders; 1923.
Newcombe GN, Rounsefell BF, Macintyre P. Pain relief with bupivacaine given through a sciatic nerve catheter. Anaesth Intensive Care 1989; 17: 370–2.
Smith BE, Fischer HBJ, Scott PV. Continuous sciatic nerve block. Anaesthesia 1984; 39: 155–7.
Sutherland IDB. Continuous sciatic nerve infusion: expanded case report describing a new approach. Reg Anesth Pain Med 1998; 23: 496–501.
Chang PC, Lang SA, Yip RW. Reevaluation of the sciatic nerve block. Reg Anesth 1993; 18: 18–23.
Mansour NY. Reevaluating the sciatic nerve block: another landmark for consideration (Letter). Reg Anesth 1993; 18: 322–3.
Morris GF, Lang SA. Continuous parasacral sciatic nerve block: two case reports. Reg Anesth 1997; 22: 469–72.
Hadzic A, Vloka JD. A comparison of posterior versus lateral approaches to the block of the sciatic nerve in the popliteal fossa. Anesthesiology 1998; 88: 1480–6.
Author information
Authors and Affiliations
Corresponding author
Additional information
Department and institution of attribution of the work: Department of Anesthesiology and Intensive Care, Erasmus Hospital, Lenniklaan, Brussels, Belgium
Rights and permissions
About this article
Cite this article
Pandin, P., Vandesteene, A. & D’Hollander, A. Sciatic nerve blockade in the supine position: a novel approach. Can J Anesth 50, 52–56 (2003). https://doi.org/10.1007/BF03020187
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03020187