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Canadian Journal of Anesthesia

, Volume 50, Issue 1, pp 52–56 | Cite as

Sciatic nerve blockade in the supine position: a novel approach

  • Pierre Pandin
  • Arlette Vandesteene
  • Alain D’Hollander
Regional Anesthesia and Pain

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.

Keywords

Bupivacaine Sciatic Nerve Catheter Insertion Motor Block Sciatic Nerve Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le blocage du nerf sciatique en décubitus dorsal : une nouvelle approche

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.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Pierre Pandin
    • 1
  • Arlette Vandesteene
    • 1
  • Alain D’Hollander
    • 1
  1. 1.Department of Anesthesiology, Erasmus HospitalFree University of BrusselsBrusselsBelgium

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