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Canadian Journal of Anesthesia, Vol 43, 964-967, Copyright © 1996 by Canadian Anesthesiologists' Society

ARTICLES

Supine approach to the sciatic nerve in the popliteal fossa

JD Vloka, A Hadzic, R Koorn and D Thys
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.

PURPOSE: Sciatic nerve block in the popliteal fossa (popliteal nerve block, PNB) is an anaesthetic technique well-suited for operations below the knee. However, difficulty with positioning the patient in the prone position often precludes the classical, posterior approach to the block. In this report, an alternative approach to PNB that can easily be performed with a patient in the supine position is described. CLINICAL FEATURES: Three patients in whom the clinical circumstances precluded the use of the classical approach to PNB are described. In each case, PNB was performed using the alternative, supine approach. With a patient in the supine position, the leg is flexed at both the hip and knee, and supported by an assistant. After the anatomical landmarks of the popliteal fossa are identified, an insulated needle attached to a peripheral nerve stimulator is inserted 7 cm above the popliteal crease, 1 cm laterally to the midline and directed 45 degrees cephalad. Upon obtaining either dorsal or plantar flexion of the foot at the output current of 0.5 mAmp or less. 30-40 ml of local anaesthetic solution are injected. CONCLUSION: The supine approach to PNB allows the use of the block in patients that cannot be positioned in the prone position. Flexion of the leg at the knee greatly facilitates identification of the anatomical landmarks. When combined with a block of the femoral or saphenous nerve, this technique provides excellent anaesthesia for patients undergoing foot and ankle surgery.


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Copyright © 1996 by the Canadian Anesthesiologists' Society.