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Abstract
Background and Aims Current approaches to sciatic nerve block either require position change, which is time consuming, or involves blocking the sciatic nerve deeper in the tissue. To perform the block in supine position, patient’s knee is flexed in unsteady position, requiring assistant or sandbag under the ankle to maintain this position. Medial approach described in current literature position patient‘s leg in figure-of-four which is difficult in patients with hip or knee conditions. We propose a novel convenient way of positioning patient’s lower limb of interest above contralateral ankle for medial approach to sciatic nerve block in two case studies.
Methods Sciatic nerve block was performed in two patients under ultrasound guidance with their lower limb of interest positioned above contralateral ankle.
Results Sciatic nerve block was performed successfully for anaesthesia intraoperatively in both patients. Our proposed position was time efficient with ease of positioning in supine position without need for support and femoral/saphenous nerve block was performed in the same position. Sciatic nerve appears more elongated on ultrasound when approached medially, allowing greater surface area for spread of local anesthesia. Vascular structures were further from sciatic nerve, reducing the risk of intravascular injection of local anaesthesia. With tibial nerve approached first medially, risk of common peroneal nerve injury could be reduced compared to lateral approach.
Conclusions Our proposed position for medial approach of sciatic nerve block saves positioning time, with greater surface area for spread of local anesthesia, likely reducing the risk of intravascular injection of local anaesthesia and common peroneal nerve injury.