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Ultrasound-guided proximal sciatic block

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One form of proximal sciatic nerve block which is relatively easy to perform involves a subgluteal, lateral approach to the nerve. This technique is reminiscent of the „classical“ subtrochanteric access (see the respective section). For a good display of the nerve along its course on the dorsal side of the thigh, it is appropriate to elevate the lower leg of the patient with a positioning aid (e.g. an arm rest). In most cases it is easy to track the sciatic nerve from the popliteal space in a proximal direction. The primary anatomic landmark here is the long head of the femoral biceps muscle, below which the nerve passes on its mediolateral path.

 

The Technique

As described above, the nerve is shown in the subgluteal region. The puncture path starts laterally and proceeds along the long axis towards the nerve. In the ideal case, local anaesthetic is deposited via injection both above and below the nerve.

Nota bene: Use of the sector abdominal transducer is sometimes to be recommended for a thick thigh due to the required penetration depth.

 

Sonoanatomic Landmarks

Path of the sciatic nerve

proximal ischiadicus sono1