Anterior approach, sciatic nerve block

[epidural man]

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Has anyone ever done an anterior approach to the sciatic nerve? I would like to try it but no one around here has tried it before.

MilMD (president of SARA), what are your thoughts?

 

[BLADEMDA]

Has anyone ever done an anterior approach to the sciatic nerve? I would like to try it but no one around here has tried it before.

MilMD (president of SARA), what are your thoughts?

Another way to skin a cat. Go to www.NYSORA.com and look at the approach. Please use a 6 inch long needle and don't do this approach in the EXTREMELY morbidly obese patient.

The advantage of the Anterior approach is that a Femoral/Sciatic can be performed in the same position and on patients with acute fractures.


Blade

 

[milrisome]

Has anyone ever done an anterior approach to the sciatic nerve? I would like to try it but no one around here has tried it before.

Tried it once a few weeks ago. Turned out to be quite painful and required a lot of sedation. Kept hitting the femur. Couldn't do the inward rotation at the ankle they recommend b/c pt would scream in pain due to the injury. Couldn't get it, so turned lateral and got it easily.

N=1, success=0.

 

[Dejavu]

I've done upwards of fifty, gave it up because, apparently, there is a little evidence of poorer quality block than the classic approach and evidence of more infection risk. Plus almost all my colleagues do it the classic way. I decided it doesn't pay to be an outlier, plus it doesn't take long to reposition the patient and the classic posterior approach is rather dependable. I have one colleague that does them sub-gluteally with good success.

 

[epidural man]

If you do the femoral nerve block first, does this help block the pain of the sciatic approach?

It looks like your needle insertion is below your fem block, so theoretically the fem block will help numb those anterior muscles and help you a bunch.

 

[Dejavu]

No, actually I always did the sciatic first, then the femoral. Haven't done an anterior approach in quite a few months now.

 

[milrisome]

If you do the femoral nerve block first, does this help block the pain of the sciatic approach?

It looks like your needle insertion is below your fem block, so theoretically the fem block will help numb those anterior muscles and help you a bunch.

My understanding (from recently studying this block) is that you don't want to numb up the femoral nerve first, b/c then you will (probably) be going in and out with your needle to find the sciatic nerve and you wouldn't recognize it if you got too close to the femoral nerve.