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High-Definition Ultrasound Imaging Defines the Paraneural Sheath and the Fascial Compartments Surrounding the Sciatic Nerve at the Popliteal Fossa
  1. Manoj Kumar Karmakar, MD*,
  2. Ali Nima Shariat, MD,
  3. Pawinee Pangthipampai, MD* and
  4. Junping Chen, MD
  1. *Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China; and †Department of Anesthesiology, St Luke’s-Roosevelt Hospital Center, New York, NY.
  1. Address correspondence to: Manoj Kumar Karmakar, MD, Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China (e-mail: karmakar{at}cuhk.edu.hk).

Abstract

Background and Objectives The connective tissue layers that surround the sciatic nerve at the popliteal fossa are poorly defined. We present high-definition ultrasound images of the sciatic nerve, which were acquired during ultrasound-guided popliteal sciatic nerve block (SNB), that clearly demonstrate these fascial layers.

Methods Four patients undergoing hallux valgus surgery received an ultrasound-guided popliteal SNB using a high-definition ultrasound system. In the ultrasound images, the paraneural sheath was identified as a hyperechoeic fascial layer between the outer surface of the sciatic nerve (epineurium) and the epimysium of the surrounding muscles. The paraneural sheath was distinct from the epineurium, better delineated after the local anesthetic injection, and enveloped not only the sciatic nerve but also the common peroneal and tibial nerves separately. In the postblock sonograms, the local anesthetic was compartmentalized into 2 broad areas, that is, external (subepimyseal) and internal (subparaneural) to the paraneural sheath. The popliteal SNB was effective for surgical anesthesia in all 4 patients.

Conclusions We have demonstrated the paraneural sheath and the fascial compartments, that is, the “subepimyseal perineural compartment” and the “subparaneural compartment” that surround the sciatic nerve and act as conduits for local anesthetic spread during a popliteal SNB.

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Footnotes

  • The authors declare no conflict of interest.

    This work was locally funded by the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China.

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