Sciatic nerve block is frequently used for anaesthesia or analgesia during orthopaedic foot surgery. Although anatomical landmarks provide valuable clues to the position of the sciatic nerve, they are only surrogate markers, can vary in patients, and may be difficult to locate in obese patients.
The ultrasound (US)-guided approach may reduce the risk of femoral artery puncture compared with the landmark-based approach.
The sciatic nerve is imaged approximately at the level of the minor trochanter. At this location, a curved transducer SIFULTRAS-5.21 placed over the anteromedial aspect of the thigh will reveal the musculature of all three fascial compartments of the thigh: anterior, medial, and posterior.
Beneath the sartorius muscle is the femoral artery, and deep and medial to this vessel is the deep artery of the thigh. Both can be identified with color Doppler US for orientation. The femur is seen as a hyperechoic rim with a corresponding shadow beneath the vastus intermedius.
The subgluteal space, where the sciatic nerve is located, is a well-defined anatomical space and can be identified using ultrasound at the level of the greater trochanter and ischial tuberosity. We have also shown that local anaesthetic injected into the subgluteal space under ultrasound guidance is effective in producing SNB.
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