Sciatic Block...whats your favorite technique

[turnupthevapor]

I have a linear 8-12 mhz linear probe and most pts have a BMI >30 in my area. Just wondering what everyones favorite sciatic technique is?

I find the classical technique to be a little to much fishing for me and have trouble sometimes finding the sciatic nerve subgluteal with my probe. What is your favorites?

thanks in advance

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[sevoflurane]

I have a linear 8-12 mhz linear probe and most pts have a BMI >30 in my area. Just wondering what everyones favorite sciatic technique is?

I find the classical technique to be a little to much fishing for me and have trouble sometimes finding the sciatic nerve subgluteal with my probe. What is your favorites?

thanks in advance

I guess it depends on what I'm trying to accomplish. For knees, I like anterior approach or "high" popliteal with USD if they are heavy. For hips I like parasacral. For BKA's I like subgluteal catheters.

 

[nap$ter]

I have a linear 8-12 mhz linear probe and most pts have a BMI >30 in my area. Just wondering what everyones favorite sciatic technique is?

I find the classical technique to be a little to much fishing for me and have trouble sometimes finding the sciatic nerve subgluteal with my probe. What is your favorites?

thanks in advance

lumbar epidural approach; no ultrasound, no stim

 

[dbiddy808]

I work at a trauma center, so around 50% of my patients cannot go prone. I never sciatics prone anymore. For foot cases, I do lateral popliteal around 10-12 cm proximal to popliteal crease. I supplement this with saphenous field block. For knees I usually do combined femoral/sciatic from anterior in groin area. I do all these with just nerve stimulator and 2-5 mg versed +/1 50-100 fentanyl. Add a little chlorhexadine and gloves and it takes 1-5 mins. Unfortunately we have no ultrasound, but I doubt it would save all that much time. Easy money.

 

[Noyac]

anterior approach

 

[thegasman]

subgluteal. would like to learn anterior but my group honestly does very few of these anyway. the surgeons just don't want it.

 

[Noyac]

subgluteal. would like to learn anterior but my group honestly does very few of these anyway. the surgeons just don't want it.

I never asked the surgeons if they wanted it. Do a couple and they will come around.

 

[Mman]

Favorite technique? Depends what the block is for. Good old fashioned classic Labat works like a charm for knee surgery. It's quick and easy in most patients if you know the landmarks and have enough experience. Takes all of 2 minutes to do and works > 95% of the time.

If they are having something on the foot or ankle, I like to do a nice ultrasound guided popliteal with an in plane approach (from lateral needle entry). It's very easy to image and works well. Popliteal approach definitely takes a little longer to set up than more proximal blocks so you need to keep that in mind if using for primary anesthesia.

I find it almost pointless to use ultrasound for any sciatic above the popliteal. People are too fat and they are no vascular landmarks to help you identify the nerve. It ends up adding way too much time for too little benefit.