Popliteal (Sciatic) Nerve Block

  • Sciatic nerve usually splits 8-10 cm above the popliteal space
  • The medial portion of the lower leg receives innervation from the femoral nerve via the saphenous nerve and that this can extend around to the midline of the posterior side of the leg
  • Consider performing a saphenous block


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Indications

  • Lower leg and foot excluding Medial aspect
  • Peripheral Nerve Stimulation
  • Neuralgia
  • Foot Pain

Popliteal Nerve Block

  • 7-MHz probe up to the popliteal fossa, where it divides into the peroneal and tibial nerves 
  • Sciatic nerve often appears round and hyperechoic 
  • Located posterior to the femur, lateral to the popliteal artery, and deep (anterior) to the semitendinous and semimembranous muscles medially and the biceps femoris muscle laterally
  • More distally, the peroneal nerve may be followed as far laterally as the head of the fibula

Common Peroneal Nerve & Tibial Nerve

Popliteal Nerve Block

Popliteal Nerve Block Precautions

  • Local anesthetic solution appears as a hypoechoic (black) space surrounding both nerve branches

  • Longer time until onset

  • Longer duration

  • Fall precautions

References

and Interesting Articles

  • Gedikoglu M, Eker HE. Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia. Pol J Radiol. 2019 Dec 13;84:e537-e541. doi: 10.5114/pjr.2019.91271. PMID: 32082452; PMCID: PMC7016492.
  • Hashimoto A, Ito H, Sato Y, Fujiwara Y. The efficacy and safety of continuous popliteal sciatic nerve block for the relief of pain associated with critical limb ischemia: a retrospective study. Open J Anesthesiol. 2013;3:433–437.
  • Desai A, Carvalho B, Hansen J, Hill J. Ultrasound-guided popliteal nerve block in a patient with malignant degeneration of neurofibromatosis 1. Case Rep Anesthesiol. 2012;2012:753769. doi: 10.1155/2012/753769. Epub 2012 May 9. PMID: 22649742; PMCID: PMC3357589.

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