Influence of leg position on the depth and sonographic appearance of the sciatic nerve in volunteers

Abstract

We investigated the effect of leg position on the depth of the sciatic nerve and quality of ultrasound images taken at the proximal and mid-thigh level. Twenty-one volunteers with average body mass index were recruited to represent the younger population receiving sciatic nerve blocks for sports injury surgery. The volunteers were placed in the lateral position, with the hip flexed and with the hip in a neutral (extended) position. A single operator imaged the uppermost leg and the best images of the sciatic nerve at the proximal and mid-thigh level were saved. Sciatic nerve depth was measured at each level. Eleven clinicians experienced in ultrasound-guided regional anaesthesia assessed the paired images. In the proximal thigh, the sciatic nerve depth was greater with the hip flexed compared to the neutral position (median 30 vs 23 mm, P=0.0002). There was no consistent difference in the mid-thigh. More clinicians favoured the proximal sciatic image with the leg in the neutral position. Although statistically significant, the depth difference is probably not a major clinical consideration in most patients with an average body mass index. We suggest clinicians place the leg in the most ergonomically favourable position when performing sciatic nerve blocks in the proximal thigh in these patients.