Article Text

Download PDFPDF
Ultrasound-Guided Single-Penetration Dual-Injection Block for Leg and Foot Surgery: A Prospective, Randomized, Double-blind Study
  1. Jens Børglum, MD, PhD*,
  2. Karina Johansen, MD*,
  3. Margrethe D. Christensen, MD*,
  4. Katja Lenz, MD*,
  5. Thomas F. Bendtsen, MD, PhD,
  6. Katrine Tanggaard*,
  7. Anders F. Christensen, MD, PhD,
  8. Bernhard Moriggl, MD, PhD§ and
  9. Kenneth Jensen, MD, BBA*
  1. *Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark
  2. Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark
  3. Department of Radiology, Copenhagen University Hospital, Bispebjerg, Denmark
  4. §Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria
  1. Address correspondence to: Jens Børglum, MD, PhD, Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark (e-mail: jens.borglum{at}


Background and Objectives We describe a new approach to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration dual-injection (SPEDI) technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. We introduce an alternative, effective, and possibly faster method.

Methods Sixty patients undergoing leg and foot surgery under general anesthesia were included. We deposited 15 mL of ropivacaine 0.75% around the sciatic nerve (SCN) and 5 mL of ropivacaine 0.75% at the SAN. Patients were randomized to the popliteal-sciatic/saphenous technique or the SPEDI technique. The primary outcome measure was performance time. Positioning time, pain assessment, nausea in the postanesthesia care unit, sufentanil demand, dermatomal anesthesia, and degree of motor blockade were also recorded.

Results Performance time was significantly faster with the SPEDI technique (median time, 110 seconds [range, 57–315 seconds] vs 246 seconds [range, 163–472 seconds]; P < 0.0001). Positioning time was significantly shorter with the SPEDI technique (P < 0.0001). No other statistically significant differences were recorded.

Conclusions The SPEDI block resulted in significantly faster performance time and reduced positioning time with statistically equal efficacy in relation to pain assessment, nausea, sufentanil demand, dermatomal anesthesia, and motor blockade. The SPEDI block is statistically an equally effective alternative to the traditional popliteal-sciatic/saphenous block combination for leg and foot surgery, but it is faster, requires only 1 skin penetration, and does not require repositioning of the leg.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflict of interest.

    The Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital (Bispebjerg, Denmark) financed this study.

    Select preliminary data were presented by Dr K. Johansen et al at the 31st Annual European Society of Regional Anaesthesia and Pain Therapy Congress in Bordeaux, France, September 5–8, 2012, and by Dr M.D. Christensen et al at the Annual Meeting of the Danish Society for Anaesthesiology and Intensive Care Medicine in Copenhagen, Denmark, November 2012.