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REGIONAL ANESTHESIA AND PAIN MEDICINE

The Division of the Sciatic Nerve in the Popliteal Fossa: Anatomical Implications for Popliteal Nerve Blockade

Jerry D. Vloka, MD, PhD^*, Admir Hadi, MD, PhD^*, Ernest April, PhD, and Daniel M. Thys, MD

Departments of *Clinical Anesthesiology and Anesthesiology, St. Luke’s-Roosevelt Hospital Center; and the Department of Anatomy, Columbia University College of Physicians and Surgeons, New York, New York

Address correspondence and reprint requests to Admir Hadi, MD, PhD, Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025. Address e-mail to ah149{at}columbia.edu

The sciatic nerve (SN) originates from the L4-S3 roots in the form of two nerve trunks: the tibial nerve (TN) and the common peroneal nerve (CPN). The TN and CPN are encompassed by a single epineural sheath and eventually separate (divide) in the popliteal fossa. This division of the SN occurs at a variable level above the knee and may account for frequent failures reported with the popliteal block. We studied the level of division of the SN in the popliteal fossa and its relationship to the common epineural sheath of the SN. The level of division of the SN sheath into TN and CPN above the knee was measured in 28 cadaver leg specimens. The SN was invariably formed of independent trunks (TN and CPN) encompassed in one common epineural sheath. The SN divided at a mean distance of 60.5 ± 27.0 mm (range 0 to 115 mm) above the popliteal fossa crease. We conclude that the TN and CPN leave the common SN sheath at variable distances from the popliteal crease. This finding and the relationship of the TN and CPN sheaths may have significant implications for popliteal block.

Implications: When performing popliteal block, insertion of the needle at 100 mm above the popliteal crease is more likely to result in placement of the needle proximal to the division of the sciatic nerve than placement at 50 or 70 mm, according to the classical teaching.

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