MEDIAL TECHNIQUE FOR COMBINED POPLITEAL SCIATIC AND SAPHENOUS NERVE BLOCKADE

Abstract

Background and aims: Combined popliteal sciatic and saphenous nerve blockade for lower extremity anesthesia is a widely accepted practice. Combined sciatic and saphenous nerve blockade under ultrasound guidance from the medial approach is described. This technique is performed faster than the two injection technique, does not require repositioning, and significantlyreduces both pain and risk of infection. Future advances in needle technology will allow continuous nerve blockade by this approach. Methods: With the patient supine the lower extremity is externally rotated and the knee and hip are slightly flexed. The adductor groove and saphenous nerve are identified by ultrasound and the probe is placed in the popliteal fossa to identify the sciatic nerve. The needle is inserted medially at the saphenous nerve injection site and advanced to the sciatic nerve and local anesthetic is injected. The needle is withdrawn to the saphenous nerve and the remainder of local anesthetic is injected. Results: Combined sciatic and saphenous nerve blockade using a medial approach eliminates repositioning for its performance. The single injection technique eliminates needle reinsertion, and pain from the procedure and risk of contamination from excessive ultrasound probe and needle manipulation are also reduced. Conclusions: Combined medial sciatic and saphenous nerve blockade by a single injection approach improves ease and speed of this technique by reducing the need for operator or patient repositioning and reduces the pain and risk of infection from a multiple injection approach. Future developments in needle technology will allow continuous infusions to be placed by this technique.