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Ultrasound-guided subparaneural popliteal sciatic nerve block: there is more to it than meets the eyes
  1. Manoj Kumar Karmakar1,
  2. Miguel A Reina2,
  3. Ranjith Kumar Sivakumar1,
  4. Pornpatra Areeruk1,
  5. Jatuporn Pakpirom1 and
  6. Xavier Sala-Blanch3,4
  1. 1 Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China
  2. 2 Department of Anesthesiology, CEU San Pablo University School of Medicine, Madrid, Spain
  3. 3 Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  4. 4 Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  1. Correspondence to Professor Manoj Kumar Karmakar, Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong Faculty of Medicine, Shatin, New Territories, Hong Kong, China; karmakar{at}cuhk.edu.hk

Abstract

The popliteal sciatic nerve block is routinely used for anesthesia and analgesia during foot and ankle surgery. This article reviews our current understanding of the anatomy of the sciatic nerve and discusses how fascial tissue layers associated with the nerve may affect block outcomes . The anatomy of the sciatic nerve is more complex than previously described. The tibial and common peroneal nerves within the sciatic nerve trunk appear to be centrally separated by the Compton-Cruveilhier septum and encompassed by their own paraneural sheaths. This unique internal architecture of the sciatic nerve appears to promote proximal spread of local anesthetic to the internal aspect of the sciatic nerve trunk after a subparaneural injection at or below the divergence of the tibial and common peroneal nerves.

  • ultrasonography
  • lower extremity
  • anesthesia
  • conduction

https://doi.org/10.1136/rapm-2020-101709

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    Footnotes

    • Twitter @Ranjith_SRK

    • Contributors MKK was involved with conception, planning and design of the report, review of the literature, and preparation of manuscript. MAR was involved with review of microanatomic data and editing the manuscript. RKS was involved with review of the literature, obtaining the sonographic images, and editing the manuscript. PA was involved with editing the sonographic images, and editing the manuscript. JP was involved with editing the ultrasound images and manuscript. XS-B was involved with review of microanatomic data and editing the manuscript.

    • Funding This work was locally funded by the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.