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Sciatic nerve block in the popliteal fossa: description of a new medial approach

[Le bloc du nerf sciatique dans le creux poplité : une nouvelle approche médiale]

Emmanuel Guntz, MD^*, Pierre Herman, MD^*, Eric Debizet, MD^*, Damien Delhaye, MD, Very Coulic, MD^* and Maurice Sosnowski, MD, PhD^*

^* From the Departments of Anesthesiology, and
Radiology, Université Libre de Bruxelles, C.H.U Saint-Pierre, Brussels, Belgium.

Address correspondence to: Dr. Emmanuel Guntz, Anesthesiology Department, C.H.U. Saint-Pierre, rue Haute, 322, Brussels, 1000 Belgium. Phone: 003225353593; Fax: 003225354070; E-mail: eguntz{at}ulb.ac.be
Address requests for reprints to: Dr. Maurice Sosnowski, Anesthesiology Department, C.H.U. Saint-Pierre, rue Haute, 322, Brussels, 1000, Belgium. Phone: 003225353593; Fax: 003225354070; E-mail: maurice_sosnowski{at}stpierre-bru.be

Purpose: Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level.

Methods: After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected.

Results: Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30° in all directions). The leg was flexed at 130°. In this position, above the adductor tubercle, a depression known as Jobert’s fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4–8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4–9 cm). Mean time to perform the block was 100 sec (range 55–165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5–60 min) inside the common peroneal nerve area and 43 min (range 15–75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed.

Conclusion: We describe a new medial approach to the sciatic nerve in the popliteal fossa. More studies will be required to demonstrate the technique is effective and safe.

This article has been cited by other articles:

				M. Eurin, H. Beloeil, and P. J. Zetlaoui Une approche mediale pour un bloc sciatique continu par voie poplitee.: [A medial approach for a continuous sciatic block in the popliteal fossa]. Can J Anesth, November 1, 2006; 53(11): 1165 - 1166. [Full Text] [PDF]