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REGIONAL ANESTHESIA

A Comparison of Intertendinous and Classical Approaches to Popliteal Nerve Block Using Magnetic Resonance Imaging Simulation

Admir Hadi, MD PhD, Jerry D. Vloka, MD PhD, R. Singson, MD, Alan C. Santos, MD, and Daniel M. Thys

St. Luke’s-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY

Address correspondence and reprint requests to Jerry D. Vloka, MD, PhD, Department of Anesthesiology, Saint Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave., New York, NY 10025. Address e-mail to ah149{at}columbia.edu

The classical approach to sciatic nerve block in the popliteal fossa (popliteal block) often requires multiple attempts to localize the sciatic nerve. Recently, it has been suggested that an intertendinous approach to popliteal block may result in a more consistent localization of the sciatic nerve. In the current study, we compared anatomical landmarks for the intertendinous and classical approaches to popliteal block with respect to the accuracy in localizing the sciatic nerve using magnetic resonance imaging simulation. Two anesthesiologists experienced in popliteal block drew landmarks for the intertendinous and classical approaches on 10 volunteers; a 1.5 Tesla superconducting magnet was used to obtain simultaneous, 10-mm thick, fast-spin echo proton density transverse ax- ial sequences of the lower extremities. Using these acquired images, the two approaches were simulated offline using previously identified landmarks. The spatial relationships of the simulated needle paths to the nerves and vessels in the popliteal fossa, as well as other relevant structures, were measured and compared. Simulation of the intertendinous approach to popliteal block resulted in needle-to-sciatic nerve contact in 14 legs (70%) versus 5 legs (25%) when the classical approach was used (P < 0.05). We conclude that the intertendinous approach might result in a more consistent localization of the sciatic nerve and may decrease the risk of sciatic vessel puncture.

IMPLICATIONS: A simulation of popliteal block using magnetic resonance imaging in volunteers suggests that using tendons of the hamstring muscles as the anatomical landmarks yields a more consistent localization of the sciatic nerve.

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