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 Web of Science 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 Web of Science (36) Citing Articles via Google Scholar Google Scholar Articles by Paqueron, X. Articles by Benhamou, D. Search for Related Content PubMed PubMed Citation Articles by Paqueron, X. Articles by Benhamou, D.

---

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.

This article has been cited by other articles:

				M. T. Muniz, J. Rodriguez, M. Bermudez, C. Valino, N. Blanco, M. Amor, P. Aguirre, A. Masid, J. Cortes, J. Alvarez, et al. Low Volume and High Concentration of Local Anesthetic Is More Efficacious than High Volume and Low Concentration in Labat's Sciatic Nerve Block: A Prospective, Randomized Comparison Anesth. Analg., December 1, 2008; 107(6): 2085 - 2088. [Abstract] [Full Text] [PDF]

				E. Dufour, P. Quennesson, A. L. Van Robais, F. Ledon, P.-A. Laloe, N. Liu, and M. Fischler Combined Ultrasound and Neurostimulation Guidance for Popliteal Sciatic Nerve Block: A Prospective, Randomized Comparison with Neurostimulation Alone Anesth. Analg., May 1, 2008; 106(5): 1553 - 1558. [Abstract] [Full Text] [PDF]

				A. Pianezza, M.-L. Gilbert, V. Minville, D. Filsinger, Q. Gobert, A. Guerot, R. Fuzier, and O. Fourcade A Modified Mid-Femoral Approach to the Sciatic Nerve Block: A Correlation Between Evoked Motor Response and Sensory Block Anesth. Analg., August 1, 2007; 105(2): 528 - 530. [Abstract] [Full Text] [PDF]

				X. March, O. Pineda, M. M. Garcia, D. Carames, and A. Villalonga The Posterior Approach to the Sciatic Nerve in the Popliteal Fossa: A Comparison of Single- Versus Double-Injection Technique Anesth. Analg., December 1, 2006; 103(6): 1571 - 1573. [Abstract] [Full Text] [PDF]

				M. Taboada, J. Rodriguez, C. Valino, J. Carceller, B. Bascuas, J. Oliveira, J. Alvarez, F. Gude, and P. G. Atanassoff What Is the Minimum Effective Volume of Local Anesthetic Required for Sciatic Nerve Blockade? A Prospective, Randomized Comparison Between a Popliteal and a Subgluteal Approach Anesth. Analg., February 1, 2006; 102(2): 593 - 597. [Abstract] [Full Text] [PDF]

				M. Taboada, J. Rodriguez, S. Del Rio, J. Lagunilla, J. Carceller, J. Alvarez, and P. G. Atanassoff Does the Site of Injection Distal to the Greater Trochanter Make a Difference in Lateral Sciatic Nerve Blockade? Anesth. Analg., October 1, 2005; 101(4): 1188 - 1191. [Abstract] [Full Text] [PDF]

				M. Taboada, P. G. Atanassoff, J. Rodriguez, J. Cortes, S. Del Rio, J. Lagunilla, F. Gude, and J. Alvarez Plantar Flexion Seems More Reliable than Dorsiflexion with Labat's Sciatic Nerve Block: A Prospective, Randomized Comparison Anesth. Analg., January 1, 2005; 100(1): 250 - 254. [Abstract] [Full Text] [PDF]

				D. Jochum, G. Iohom, O. Choquet, D. Macalou, S. Ouologuem, P. Meuret, F. Kayembe, M. Heck, P.-M. Mertes, and H. Bouaziz Adding a Selective Obturator Nerve Block to the Parasacral Sciatic Nerve Block: An Evaluation Anesth. Analg., November 1, 2004; 99(5): 1544 - 1549. [Abstract] [Full Text] [PDF]

				M. Taboada, J. Alvarez, J. Cortes, J. Rodriguez, S. Rabanal, F. Gude, A. Atanassoff, and P. G. Atanassoff The Effects of Three Different Approaches on the Onset Time of Sciatic Nerve Blocks with 0.75% Ropivacaine Anesth. Analg., January 1, 2004; 98(1): 242 - 247. [Abstract] [Full Text] [PDF]

				G. Ekatodramis, J. M. Bonvini, A. Borgeat, A. Casati, and G. Fanelli The Effects of Single or Multiple Injections on the Volume of 0.5% Ropivacaine Required for Femoral Nerve Blockade Response Anesth. Analg., February 1, 2002; 94(2): 475 - 476. [Full Text] [PDF]

				J. D. Vloka, A. Hadzic, E. April, and D. M. Thys The Division of the Sciatic Nerve in the Popliteal Fossa: Anatomical Implications for Popliteal Nerve Blockade Anesth. Analg., January 1, 2001; 92(1): 215 - 217. [Abstract] [Full Text] [PDF]

				B. P. Kinirons, H. Bouaziz, X. Paqueron, A. Ababou, C. Jandard, M. M. Cao, M.-L. Bur, M.-C. Laxenaire, and D. Benhamou Sedation with Sufentanil and Midazolam Decreases Pain in Patients Undergoing Upper Limb Surgery Under Multiple Nerve Block Anesth. Analg., May 1, 2000; 90(5): 1118 - 1121. [Abstract] [Full Text] [PDF]