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REGIONAL ANESTHESIA

Does the Sciatic Nerve Approach Influence Thigh Tourniquet Tolerance During Below-Knee Surgery?

Régis Fuzier, MD^*, Pierre Hoffreumont, MD, Sophie Bringuier-Branchereau, PharmD, Xavier Capdevila, MD, PhD, and François Singelyn, MD, PhD^*

*Department of Anesthesiology, Université Catholique de Louvain School of Medicine, Brussels, Belgium; Clinique Saint Pierre, Ottignies, Belgium; Department of Anesthesiology, Hôpital Lapeyronie, Montpellier, France

Address correspondence and reprint requests to F.J. Singelyn, MD, PhD, Department of Anesthesiology, St Luc Hospital, Avenue Hippocrate 10/1821–B 1200 Brussels–Belgium. Address e-mail to singelyn{at}anes.ucl.ac.be.

In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when a Labat’s or a posterior popliteal approach of the sciatic nerve was used for below-knee surgery. One-hundred-twenty patients were divided into two groups of 60. A posterior popliteal (Group 1) or a Labat’s (Group 2) sciatic nerve block was performed with 25 mL 1% mepivacaine + epinephrine 1:200,000. In both groups, a femoral nerve block was achieved. Patient comfort during block performance, sensory block, success rate, and thigh tourniquet tolerance were recorded. Performance of the block was significantly more comfortable in Group 1 than in Group 2 (P < 0.01). Completeness of the block at t_{30 min.} and success rate were comparable in both groups. Thigh tourniquet pain increased with time in both groups. No statistically significant difference was observed between groups. We conclude that despite a complete sensory blockade of the posterior femoral cutaneous nerve in 91% of the patients, Labat’s approach of the sciatic nerve provides no better thigh tourniquet tolerance than the popliteal approach. The popliteal approach is as efficient but more comfortable for the patient and is the preferred technique for below-knee surgery.

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