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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Lateral Approach to the Sciatic Nerve at the Popliteal Fossa: One or Two Injections?

Xavier Paqueron, MD^*, Hervé Bouaziz, MD, Dioukamady Macalou, MD, Thierry Labaille, MD^*, Michel Merle, MD, Marie Claire Laxenaire, MD, and Dan Benhamou, MD^*

*Department of Anesthesiology and Intensive Care, Hôpital Antoine Béclère, Clamart cedex; Department of Anesthesiology and Intensive Care, Hôpital Central, Nancy cedex; and Department of Orthopedic Surgery, Hôpital Jeanne d’Arc, Toul cedex, France

Address correspondence and reprint requests to Dr. Hervé Bouaziz, Hôpital Central, 54035 Nancy cedex, France.

It has not been proven whether one or multiple nerve stimulations and injections provide a higher rate of complete sensory block in both major sciatic nerve sensory distributions below the knee when a popliteal sciatic nerve block is performed using the lateral approach. This prospective, randomized, single-blinded study compared the success rate of the sciatic nerve block using this approach when one or both major components of this nerve (i.e., tibial nerve and common peroneal nerves) are stimulated in 50 patients undergoing foot or ankle surgery. In Group 1 STIM, 24 patients received a single injection of 20 mL of a mixture of 2% lidocaine and 0.5% bupivacaine with 1:200,000 epinephrine after foot inversion had been elicited. In Group 2 STIM (n = 26), 10 mL of the same solution was injected after stimulation of each sciatic nerve component. For patients with complete sensory motor block, there was no difference in onset between groups. However, Group 2 STIM showed a greater success rate compared with the Group 1 STIM (2 STIM: 88% vs 1 STIM :54%; P = 0.007). When two stimulations were used, the onset time of anesthesia in the cutaneous distribution of the common peroneal nerves was shorter than in the tibial nerve (17.5 vs 30 min; P < 0.0001). We conclude that a two-stimulation technique provides a better success rate than a single-injection technique when a popliteal sciatic nerve block is performed using the lateral approach with 20 mL of local anesthetic.

Implications: A better success rate is achieved with a double stimulation technique than with a single injection for the sciatic nerve block via the lateral approach at the popliteal fossa when 20 mL of local anesthetics is used.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999