Sciatic nerve block in the popliteal fossa: Description of a new medial approach

Abstract

Purpose: Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level. Methods: After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected. Results: Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30° in all directions). The leg was flexed at 130°. In this position, above the adductor tubercle, a depression known as Jobert's fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4-8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4-9 cm). Mean time to perform the block was 100 sec (range 55-165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5-60 min) inside the common peroneal nerve area and 43 min (range 15-75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed. Conclusion: We describe a new medial approach to the sciatic nerve in the popliteal fossa. More studies will be required to demonstrate the technique is effective and safe.