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Is Circumferential Injection Advantageous for Ultrasound-Guided Popliteal Sciatic Nerve Block?: A Proof-of-Concept Study
  1. Richard Brull, MD, FRCPC*,
  2. Alan J. R. Macfarlane, MBChB, MRCP, FRCA,
  3. Simon J. Parrington, MBBS, FRCA*,
  4. Arkadiy Koshkin, MD* and
  5. Vincent W. S. Chan, MD, FRCPC*
  1. From the *Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; and the
  2. Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom.
  1. Address correspondence to: Richard Brull, MD, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 (e-mail: richard.brull{at}


Background: Ultrasound (US) guidance, in some instances, can increase the success rate and reduce the onset and procedure times for peripheral nerve blockade compared with traditional nerve localization techniques. The presumptive mechanism for these benefits is the ability to accurately inject local anesthetic circumferentially around the target nerve. We aimed to determine whether ensuring circumferential spread of local anesthetic is advantageous for US-guided popliteal sciatic nerve block.

Methods: Sixty-four adult patients undergoing US-guided popliteal sciatic block for elective foot and ankle surgery were randomly assigned to 1 of 2 groups, circumferential or single-location injection. Using a short-axis nerve view and out-of-plane needle approach, the needle tip was advanced to the posterior external surface of the sciatic nerve. A 30-mL local anesthetic admixture (1:1 lidocaine 2%/bupivacaine 0.5% with 1:200,000 epinephrine) was injected either entirely at this location (single location) or incrementally at multiple locations to ensure circumferential spread around the sciatic nerve (circumferential). Sensory and motor functions were assessed by a blinded observer at predetermined intervals. The primary outcome was sensory block defined as loss of sensation to pinprick in the distribution of both tibial and common peroneal nerves at 30 mins after injection.

Results: Sensory block was achieved in 94% of patients in the circumferential injection group compared with 69% in the single-location injection group (P = 0.010). There were no differences detected in block performance time, pain during block performance, or block-related complications between groups.

Conclusions Ultrasound-guided circumferential injection of local anesthetic around the sciatic nerve at the popliteal fossa can improve the rate of sensory block without an increase in block procedure time or block-related complications compared with a single-location injection technique.

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  • Dr. Vincent Chan receives equipment support and honoraria from Philips Medical Systems, SonoSite, and GE Medical.

  • This study was presented in part at the American Society of Regional Anesthesia and Pain Medicine Annual Spring Meeting and Workshops, Toronto, Ontario, Ontario, April 22-25, 2010.