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 The needle is withdrawn to the saphenous nerve and the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.