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Transgluteal approach (according to Labat)

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Anatomical landmarks

Posterior superior iliac spine, greater trochanter, sacral hiatus, ischial tuberosity

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Block technique

The patient is placed in the lateral recumbent position, with the leg to be blocked uppermost. The other leg is extended. The upper leg is bent approx. 30-40º at the hip joint and approx. 90º at the knee joint. The upper knee should rest on the table. The uppermost foot must not be “hooked behind” the calf of the bottom leg. In this position, the greater trochanter and the posterior superior iliac spine at the dorsal end of the iliac crest should be identified by touch and a mark is made at each point. A line is drawn perpendicularly from the mid-point of the line connecting these two marked points to the medial and the puncture site is marked at a point 4 to 5 cm along this line. To check this location, the connecting line between the greater trochanter and the sacral hiatus is halved. As a rule, this point is the same or in the direct vicinity as the previously marked puncture site. After disinfection and local anaesthetising of the puncture site, a puncture perpendicular to the skin surface is made with the stimulation needle (Stimuplex® D, 80 mm). Advancing the needle results at first in contractions of the gluteal musculature by means of direct stimulation. Upon bone contact, the needle should be withdrawn and advanced after correcting the direction. Contact with the sciatic nerve is encountered at a depth of 5 to 8 cm. Contractions of the calf musculature with plantar or dorsal flexion of the foot are triggered until a stimulation current of 0.2 – 0.3 mA is reached.

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