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<br /> Ultrasound-guided subgluteal<br /> sciatic nerve block<br /> Philips tutorial<br /> Francis V. Salinas, MD<br /> Staff Anesthesiologist and Section Head of Orthopedic Anesthesia<br /> Coordinator of Ultrasound-Guided Regional Anesthesia Education<br /> Virginia Mason Medical Center Department of Anesthesiology<br /> Table of contents<br /> Ultrasound-guided subgluteal sciatic nerve block<br /> 1 Introduction .......................................................................................................................................... 3<br /> 2 Clinical anatomy............................................................................................................................... 7<br /> 3 Anatomical relationships and the sonographic appearance ...............17<br /> 4 Ultrasound anatomy and techniques .........................................................................23<br /> 5 Clinical pearls and tips ..................................<a title="Subgluteal Sciatic Nerve Block Tutorial page 1" href="http://viewer.zmags.com/publication/0e668a69?page=1"> Ultrasound-guided subgluteal sciatic nerve block </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 2" href="http://viewer.zmags.com/publication/0e668a69?page=2"> Table of contents Ultrasound-guided subgluteal </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 3" href="http://viewer.zmags.com/publication/0e668a69?page=3"> 1 Introduction The sciatic nerve (SN) is derive</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 4" href="http://viewer.zmags.com/publication/0e668a69?page=4"> 1 Introduction More proximal approaches to sci</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 5" href="http://viewer.zmags.com/publication/0e668a69?page=5"> Figure 1 The surface and deeper projection of the</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 6" href="http://viewer.zmags.com/publication/0e668a69?page=6"> 1 Introduction • The absolute amount of nonneu</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 7" href="http://viewer.zmags.com/publication/0e668a69?page=7"> 2 Clinical anatomy The sciatic nerve is the pr</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 8" href="http://viewer.zmags.com/publication/0e668a69?page=8"> 2 Clinical anatomy Figure 2a </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 9" href="http://viewer.zmags.com/publication/0e668a69?page=9"> Figure 2b The muscle belly of the LHBF has been r</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 10" href="http://viewer.zmags.com/publication/0e668a69?page=10"> 2 Clinical anatomy The sciatic nerve exits the</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 11" href="http://viewer.zmags.com/publication/0e668a69?page=11"> Figure 3 The GM has been removed, exposing the pi</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 12" href="http://viewer.zmags.com/publication/0e668a69?page=12"> 2 Clinical anatomy Figure</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 13" href="http://viewer.zmags.com/publication/0e668a69?page=13"> At the caudal border of the quadratus femoris mus</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 14" href="http://viewer.zmags.com/publication/0e668a69?page=14"> 2 Clinical anatomy Figure 5 M</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 15" href="http://viewer.zmags.com/publication/0e668a69?page=15"> Figure 6 Patient is in the prone position.The sci</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 16" href="http://viewer.zmags.com/publication/0e668a69?page=16"> 2 Clinical anatomy Within the lower gluteal re</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 17" href="http://viewer.zmags.com/publication/0e668a69?page=17"> 3 Anatomical relationships and sonographic ap</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 18" href="http://viewer.zmags.com/publication/0e668a69?page=18"> 3 Anatomical relationships and sonographic ap</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 19" href="http://viewer.zmags.com/publication/0e668a69?page=19"> Figure 7b SAX ultrasound image of the SN in the s</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 20" href="http://viewer.zmags.com/publication/0e668a69?page=20"> 3 Anatomical relationships and sonographic ap</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 21" href="http://viewer.zmags.com/publication/0e668a69?page=21"> The subgluteal space is an intermuscular fascial </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 22" href="http://viewer.zmags.com/publication/0e668a69?page=22"> 3 Anatomical relationships and sonographic ap</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 23" href="http://viewer.zmags.com/publication/0e668a69?page=23"> 4 Ultrasound anatomy and techniques Patient</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 24" href="http://viewer.zmags.com/publication/0e668a69?page=24"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 25" href="http://viewer.zmags.com/publication/0e668a69?page=25"> Figure 9b Patient is in the prone position for US</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 26" href="http://viewer.zmags.com/publication/0e668a69?page=26"> 4 Ultrasound anatomy and techniques Sonogra</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 27" href="http://viewer.zmags.com/publication/0e668a69?page=27"> • The most easily identifiable structures are the</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 28" href="http://viewer.zmags.com/publication/0e668a69?page=28"> 4 Ultrasound anatomy and techniques SAX – i</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 29" href="http://viewer.zmags.com/publication/0e668a69?page=29"> • Needle placement and local anesthetic injection</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 30" href="http://viewer.zmags.com/publication/0e668a69?page=30"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 31" href="http://viewer.zmags.com/publication/0e668a69?page=31"> Figure 10b Ultrasound transducer position and nee</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 32" href="http://viewer.zmags.com/publication/0e668a69?page=32"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 33" href="http://viewer.zmags.com/publication/0e668a69?page=33"> Figure 11a The needle tip has been advanced over </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 34" href="http://viewer.zmags.com/publication/0e668a69?page=34"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 35" href="http://viewer.zmags.com/publication/0e668a69?page=35"> Figure 11c The needle tip is located deep to the </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 36" href="http://viewer.zmags.com/publication/0e668a69?page=36"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 37" href="http://viewer.zmags.com/publication/0e668a69?page=37"> FPO – If needle visualization is less than ideal,</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 38" href="http://viewer.zmags.com/publication/0e668a69?page=38"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 39" href="http://viewer.zmags.com/publication/0e668a69?page=39"> Video 1 SAX, In-Plane Technique. The block needle</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 40" href="http://viewer.zmags.com/publication/0e668a69?page=40"> 4 Ultrasound anatomy and techniques </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 41" href="http://viewer.zmags.com/publication/0e668a69?page=41"> Video 3 SAX, In-Plane Technique. The block needle</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 42" href="http://viewer.zmags.com/publication/0e668a69?page=42"> 4 Ultrasound anatomy and techniques Subglute</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 43" href="http://viewer.zmags.com/publication/0e668a69?page=43"> 5 Clinical pearls and tips Anisotropy of the s</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 44" href="http://viewer.zmags.com/publication/0e668a69?page=44"> 5 Clinical pearls and tips iv. The duration of</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 45" href="http://viewer.zmags.com/publication/0e668a69?page=45"> 6 References 1. Enneking FK, Chan V, Greger J, </a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 46" href="http://viewer.zmags.com/publication/0e668a69?page=46"> 6 References 13. Chan VW, Nova H, Abbas S, et al</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 47" href="http://viewer.zmags.com/publication/0e668a69?page=47"> Additional resources Additional resources relat</a> <a title="Subgluteal Sciatic Nerve Block Tutorial page 48" href="http://viewer.zmags.com/publication/0e668a69?page=48"> Philips Healthcare is part of Royal Philips Elect</a>