This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ota, J. Articles by Saito, Y. Search for Related Content PubMed PubMed Citation Articles by Ota, J. Articles by Saito, Y. Related Collections Regional Anesthesia

---

ANALGESIA

Ultrasound-Guided Anterior Approach to Sciatic Nerve Block: A Comparison with the Posterior Approach

From the Department of Anesthesiology, Shimane University School of Medicine, Izumo City, Japan.

Address correspondence to Shinichi Sakura, MD, Department of Anesthesiology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo City, 693-8501, Japan. Address e-mail to ssakura{at}med.shimane-u.ac.jp.

Abstract

BACKGROUND: Although the anterior approach to the sciatic nerve block has rarely been performed due to lack of reliable surface anatomical landmarks and technical difficulty, ultrasound guidance may make performance of this approach easier. In this study, we evaluated the clinical use of the ultrasound-guided anterior approach to sciatic nerve block and compared this approach with the posterior approach in adults.

METHODS: One hundred patients undergoing minor knee surgery were randomly divided into two groups to receive anterior and posterior (subgluteal) approaches to sciatic nerve block, using 1.5% mepivacaine 20 mL with epinephrine combined with femoral and lateral femoral cutaneous nerve blocks. Both approaches to sciatic nerve block were performed using a low-frequency, 5 to 2 MHz, curved array transducer. Measurements included block execution time, depth and size of the nerve, needle depth, onset time of sensory and motor blockade, and duration of the block.

RESULTS: The sciatic nerve was located significantly deeper and the needle depth was significantly greater in patients undergoing the anterior approach compared with the subgluteal approach. Both approaches were similar for execution time of sciatic nerve block, but the former took less time than the latter to perform all combinations of blocks. Although sensory block in the posterior femoral cutaneous nerve was achieved less often with the anterior approach compared with subgluteal approach (14.9% and 68.1%, respectively; P < 0.001), there were no differences in success rate, onset time or duration of blockade of the peroneal and tibial nerves between the two groups.

CONCLUSION: The anterior approach to sciatic nerve block is performed as easily and successfully as the posterior approach using ultrasound guidance.

This article has been cited by other articles:

				T. Saranteas Limitations in Ultrasound Imaging Techniques in Anesthesia: Obesity and Muscle Atrophy? Anesth. Analg., September 1, 2009; 109(3): 993 - 994. [Full Text] [PDF]