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REGIONAL ANESTHESIA

A New Posterior Approach to the Sciatic Nerve Block: A Prospective, Randomized Comparison with the Classic Posterior Approach

Pia di Benedetto, MD^*, Laura Bertini, MD^*, Andrea Casati, MD, Battista Borghi, MD, Andrea Albertin, MD, and Guido Fanelli, MD

*Department of Anesthesiology, CTO Roma, Roma, Italy; Department of Anesthesiology, IRCCS H San Raffaele, Vita et Salute University, Milano, Italy; and Department of Anesthesiology, IRCCS Istituti Ortopedici Rizzoli, Bologna, Italy

Address correspondence and reprint requests to Dr. Andrea Casati, Department of Anesthesiology, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milano, Italy. Address e-mail to casati.andrea{at}hsr.it

To evaluate the efficacy and acceptance of a new posterior subgluteus approach to the sciatic nerve, as compared with the classic posterior approach, 128 patients undergoing foot orthopedic procedures were randomly allocated to receive either the classic posterior sciatic nerve block (Group Labat, n = 64) or a modified subgluteus posterior approach (Group subgluteus, n = 64). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 1–0.5 mA). In Group subgluteus, a line was drawn from the greater trochanter to the ischial tuberosity; then, from the midpoint of this line, a second line was drawn perpendicularly and extended caudally for 4 cm. The end of this line represented the needle entry. In both groups, a proper sciatic stimulation was elicited at 0.5 mA; then 20 mL of 0.75% ropivacaine was injected. The time from needle insertion to successful sciatic nerve stimulation was 60 s (range, 10–180 s) with the Labat’s approach and 32 s (range, 5–120 s) with the new subgluteus approach (P = 0.0005). The depth of appropriate sciatic stimulation was 45 ± 13 mm (mean ± SD) after 2 (range, 1–7) needle redirections in Group subgluteus and 67 ± 12 mm after 4 (range, 1–10) needle redirections in Group Labat (P = 0.0001 and P = 0.00001, respectively). The failure rate was similar in both groups. Severe discomfort during the procedure was less frequent and acceptance better in Group subgluteus (5 patients [8%] and 60 patients [94%], respectively) than in Group Labat (20 patients [31%] and 49 patients [77%], respectively) (P = 0.0005 and P = 0.005, respectively). We conclude that this new subgluteus posterior approach to the sciatic nerve is an easy and reliable technique and can be considered an effective alternative to the more traditional Labat’s approach.

IMPLICATIONS: Evaluating the efficacy and acceptance of a new approach to the sciatic nerve block, this prospective, randomized study demonstrated that the new subgluteus posterior approach is an easy and reliable technique and can be considered an useful alternative to the more traditional Labat’s approach in patients undergoing foot surgery, facilitating the performance of the sciatic nerve blocks.

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