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<br /> Philips ultrasound-guided<br /> mid-thigh sciatic and popliteal<br /> sciatic nerve block 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 mid-thigh sciatic<br /> and popliteal sciatic nerve block<br /> 1 Introduction and indications .......................... 3<br /> 2 Clinical anatomy ............................................... 6<br /> 3 Anatomical relationships ............................. 13<br /> 4 Ultrasound anatomy and techniques ........ 27<br /> 5 Clinical pearls and tips .................................. 86<br /> 6 References ...................................................... 91<br /> Additional resources .............................. 94<br /> 2<br /> 1 Introduction and indications<br /> The sciatic n<a title="Sciatic Tutorial page 1" href="http://viewer.zmags.com/publication/2354d2e9?page=1"> Philips ultrasound-guided mid-thigh sciatic and p</a> <a title="Sciatic Tutorial page 2" href="http://viewer.zmags.com/publication/2354d2e9?page=2"> Table of contents Ultrasound-guided mid-thigh sc</a> <a title="Sciatic Tutorial page 3" href="http://viewer.zmags.com/publication/2354d2e9?page=3"> 1 Introduction and indications The sciatic nerve</a> <a title="Sciatic Tutorial page 4" href="http://viewer.zmags.com/publication/2354d2e9?page=4"> 1 Introduction and indications Sciatic nerve blo</a> <a title="Sciatic Tutorial page 5" href="http://viewer.zmags.com/publication/2354d2e9?page=5"> 5</a> <a title="Sciatic Tutorial page 6" href="http://viewer.zmags.com/publication/2354d2e9?page=6"> 2 Clinical anatomy The sciatic nerve is the prim</a> <a title="Sciatic Tutorial page 7" href="http://viewer.zmags.com/publication/2354d2e9?page=7"> 7</a> <a title="Sciatic Tutorial page 8" href="http://viewer.zmags.com/publication/2354d2e9?page=8"> 2 Clinical anatomy Within the lower gluteal regi</a> <a title="Sciatic Tutorial page 9" href="http://viewer.zmags.com/publication/2354d2e9?page=9"> 9</a> <a title="Sciatic Tutorial page 10" href="http://viewer.zmags.com/publication/2354d2e9?page=10"> 2 Clinical anatomy </a> <a title="Sciatic Tutorial page 11" href="http://viewer.zmags.com/publication/2354d2e9?page=11"> Figure 4 Patient in prone position. The cutaneous</a> <a title="Sciatic Tutorial page 12" href="http://viewer.zmags.com/publication/2354d2e9?page=12"> 2 Clinical anatomy The tibial and common peronea</a> <a title="Sciatic Tutorial page 13" href="http://viewer.zmags.com/publication/2354d2e9?page=13"> 3 Anatomical relationships and the sonographi</a> <a title="Sciatic Tutorial page 14" href="http://viewer.zmags.com/publication/2354d2e9?page=14"> 3 Anatomical relationships Within the mid-thigh </a> <a title="Sciatic Tutorial page 15" href="http://viewer.zmags.com/publication/2354d2e9?page=15"> Figure 5a In this view the ultrasound transducer </a> <a title="Sciatic Tutorial page 16" href="http://viewer.zmags.com/publication/2354d2e9?page=16"> 3 Anatomical relationships Figu</a> <a title="Sciatic Tutorial page 17" href="http://viewer.zmags.com/publication/2354d2e9?page=17"> Figure 5c If the transducer is rotated 90 degrees</a> <a title="Sciatic Tutorial page 18" href="http://viewer.zmags.com/publication/2354d2e9?page=18"> 3 Anatomical relationships Within the apex of th</a> <a title="Sciatic Tutorial page 19" href="http://viewer.zmags.com/publication/2354d2e9?page=19"> Figure 6a In this view the transducer is placed o</a> <a title="Sciatic Tutorial page 20" href="http://viewer.zmags.com/publication/2354d2e9?page=20"> 3 Anatomical relationships Figu</a> <a title="Sciatic Tutorial page 21" href="http://viewer.zmags.com/publication/2354d2e9?page=21"> Figure 6c The transducer is slid more distal unti</a> <a title="Sciatic Tutorial page 22" href="http://viewer.zmags.com/publication/2354d2e9?page=22"> 3 Anatomical relationships </a> <a title="Sciatic Tutorial page 23" href="http://viewer.zmags.com/publication/2354d2e9?page=23"> More distally in the popliteal fossa, the TN lies</a> <a title="Sciatic Tutorial page 24" href="http://viewer.zmags.com/publication/2354d2e9?page=24"> 3 Anatomical relationships The CPN diverges from</a> <a title="Sciatic Tutorial page 25" href="http://viewer.zmags.com/publication/2354d2e9?page=25"> Recent studies in the quantitative architecture o</a> <a title="Sciatic Tutorial page 26" href="http://viewer.zmags.com/publication/2354d2e9?page=26"> 3 Anatomical relationships • The absolute amount</a> <a title="Sciatic Tutorial page 27" href="http://viewer.zmags.com/publication/2354d2e9?page=27"> 4 Ultrasound anatomy and techniques Poplitea</a> <a title="Sciatic Tutorial page 28" href="http://viewer.zmags.com/publication/2354d2e9?page=28"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 29" href="http://viewer.zmags.com/publication/2354d2e9?page=29"> Figure 7b Lateral position. 29</a> <a title="Sciatic Tutorial page 30" href="http://viewer.zmags.com/publication/2354d2e9?page=30"> 4 Ultrasound anatomy and techniques • Scanni</a> <a title="Sciatic Tutorial page 31" href="http://viewer.zmags.com/publication/2354d2e9?page=31"> • Sonographic anatomy: – If the SN components a</a> <a title="Sciatic Tutorial page 32" href="http://viewer.zmags.com/publication/2354d2e9?page=32"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 33" href="http://viewer.zmags.com/publication/2354d2e9?page=33"> Figure 8b This 2D image is similar to 8a, but wit</a> <a title="Sciatic Tutorial page 34" href="http://viewer.zmags.com/publication/2354d2e9?page=34"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 35" href="http://viewer.zmags.com/publication/2354d2e9?page=35"> Figure 8d Color power Doppler of the popliteal ar</a> <a title="Sciatic Tutorial page 36" href="http://viewer.zmags.com/publication/2354d2e9?page=36"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 37" href="http://viewer.zmags.com/publication/2354d2e9?page=37"> Video 1 Traceback sciatic: The transducer is posi</a> <a title="Sciatic Tutorial page 38" href="http://viewer.zmags.com/publication/2354d2e9?page=38"> 4 Ultrasound anatomy and techniques The adva</a> <a title="Sciatic Tutorial page 39" href="http://viewer.zmags.com/publication/2354d2e9?page=39"> faster onset of sensory and motor block of both c</a> <a title="Sciatic Tutorial page 40" href="http://viewer.zmags.com/publication/2354d2e9?page=40"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 41" href="http://viewer.zmags.com/publication/2354d2e9?page=41"> Figure 9b The transducer is tilted (angled) sligh</a> <a title="Sciatic Tutorial page 42" href="http://viewer.zmags.com/publication/2354d2e9?page=42"> 4 Ultrasound anatomy and techniques – As the</a> <a title="Sciatic Tutorial page 43" href="http://viewer.zmags.com/publication/2354d2e9?page=43"> 2. Place the transducer in a sterile cover. After</a> <a title="Sciatic Tutorial page 44" href="http://viewer.zmags.com/publication/2354d2e9?page=44"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 45" href="http://viewer.zmags.com/publication/2354d2e9?page=45"> Figure 10b View of in-plane approach with needle </a> <a title="Sciatic Tutorial page 46" href="http://viewer.zmags.com/publication/2354d2e9?page=46"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 47" href="http://viewer.zmags.com/publication/2354d2e9?page=47"> Figure 11b The needle-tip entering the lateral as</a> <a title="Sciatic Tutorial page 48" href="http://viewer.zmags.com/publication/2354d2e9?page=48"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 49" href="http://viewer.zmags.com/publication/2354d2e9?page=49"> Figures 11c through 11f. If needle visualization </a> <a title="Sciatic Tutorial page 50" href="http://viewer.zmags.com/publication/2354d2e9?page=50"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 51" href="http://viewer.zmags.com/publication/2354d2e9?page=51"> Figure 11e The needle-tip has been repositioned s</a> <a title="Sciatic Tutorial page 52" href="http://viewer.zmags.com/publication/2354d2e9?page=52"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 53" href="http://viewer.zmags.com/publication/2354d2e9?page=53"> Figure 11g Completed ultrasound-guided popliteal </a> <a title="Sciatic Tutorial page 54" href="http://viewer.zmags.com/publication/2354d2e9?page=54"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 55" href="http://viewer.zmags.com/publication/2354d2e9?page=55"> Video 2 Popliteal sciatic nerve block: The block </a> <a title="Sciatic Tutorial page 56" href="http://viewer.zmags.com/publication/2354d2e9?page=56"> 4 Ultrasound anatomy and techniques 4. For a</a> <a title="Sciatic Tutorial page 57" href="http://viewer.zmags.com/publication/2354d2e9?page=57"> • After adequate local anesthetic distribution ar</a> <a title="Sciatic Tutorial page 58" href="http://viewer.zmags.com/publication/2354d2e9?page=58"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 59" href="http://viewer.zmags.com/publication/2354d2e9?page=59"> Figure 12b After acceptable sciatic catheter tip </a> <a title="Sciatic Tutorial page 60" href="http://viewer.zmags.com/publication/2354d2e9?page=60"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 61" href="http://viewer.zmags.com/publication/2354d2e9?page=61"> Figure 12d 2D image of epidural needle advancing </a> <a title="Sciatic Tutorial page 62" href="http://viewer.zmags.com/publication/2354d2e9?page=62"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 63" href="http://viewer.zmags.com/publication/2354d2e9?page=63"> Figure 12f 2D image of needle tip being withdrawn</a> <a title="Sciatic Tutorial page 64" href="http://viewer.zmags.com/publication/2354d2e9?page=64"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 65" href="http://viewer.zmags.com/publication/2354d2e9?page=65"> Video 3 Continuous popliteal sciatic perineural c</a> <a title="Sciatic Tutorial page 66" href="http://viewer.zmags.com/publication/2354d2e9?page=66"> 4 Ultrasound anatomy and techniques Mid-thig</a> <a title="Sciatic Tutorial page 67" href="http://viewer.zmags.com/publication/2354d2e9?page=67"> Figure 13a Patient is in prone position. A curved</a> <a title="Sciatic Tutorial page 68" href="http://viewer.zmags.com/publication/2354d2e9?page=68"> 4 Ultrasound anatomy and techniques – The ch</a> <a title="Sciatic Tutorial page 69" href="http://viewer.zmags.com/publication/2354d2e9?page=69"> The high-frequency linear array transducer will p</a> <a title="Sciatic Tutorial page 70" href="http://viewer.zmags.com/publication/2354d2e9?page=70"> 4 Ultrasound anatomy and techniques • Sonogr</a> <a title="Sciatic Tutorial page 71" href="http://viewer.zmags.com/publication/2354d2e9?page=71"> • Optimize the image by adjusting the frequency, </a> <a title="Sciatic Tutorial page 72" href="http://viewer.zmags.com/publication/2354d2e9?page=72"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 73" href="http://viewer.zmags.com/publication/2354d2e9?page=73"> Figure 14b Patient in lateral position for mid-th</a> <a title="Sciatic Tutorial page 74" href="http://viewer.zmags.com/publication/2354d2e9?page=74"> 4 Ultrasound anatomy and techniques – Prior </a> <a title="Sciatic Tutorial page 75" href="http://viewer.zmags.com/publication/2354d2e9?page=75"> 3. A 21-gauge 100 mm or 20-gauge 150 mm stimulati</a> <a title="Sciatic Tutorial page 76" href="http://viewer.zmags.com/publication/2354d2e9?page=76"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 77" href="http://viewer.zmags.com/publication/2354d2e9?page=77"> Figure 15b Needle repositioned superficial to sci</a> <a title="Sciatic Tutorial page 78" href="http://viewer.zmags.com/publication/2354d2e9?page=78"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 79" href="http://viewer.zmags.com/publication/2354d2e9?page=79"> 5. For a continuous mid-thigh sciatic catheter te</a> <a title="Sciatic Tutorial page 80" href="http://viewer.zmags.com/publication/2354d2e9?page=80"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 81" href="http://viewer.zmags.com/publication/2354d2e9?page=81"> Video 4 Mid-thigh sciatic nerve block: The block </a> <a title="Sciatic Tutorial page 82" href="http://viewer.zmags.com/publication/2354d2e9?page=82"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 83" href="http://viewer.zmags.com/publication/2354d2e9?page=83"> Figure 16b The needle has been withdrawn over the</a> <a title="Sciatic Tutorial page 84" href="http://viewer.zmags.com/publication/2354d2e9?page=84"> 4 Ultrasound anatomy and techniques </a> <a title="Sciatic Tutorial page 85" href="http://viewer.zmags.com/publication/2354d2e9?page=85"> Video 5: The 17-gauge Touhy needle approaches the</a> <a title="Sciatic Tutorial page 86" href="http://viewer.zmags.com/publication/2354d2e9?page=86"> 5 Clinical pearls and tips Anisotropy of the SN </a> <a title="Sciatic Tutorial page 87" href="http://viewer.zmags.com/publication/2354d2e9?page=87"> • In order to provide complete surgical anesthesi</a> <a title="Sciatic Tutorial page 88" href="http://viewer.zmags.com/publication/2354d2e9?page=88"> 5 Clinical pearls and tips Pharmacodynamics: ons</a> <a title="Sciatic Tutorial page 89" href="http://viewer.zmags.com/publication/2354d2e9?page=89"> iii.Blockade of the popliteal SN just distal to w</a> <a title="Sciatic Tutorial page 90" href="http://viewer.zmags.com/publication/2354d2e9?page=90"> 5 Clinical pearls and tips ii. The duration of p</a> <a title="Sciatic Tutorial page 91" href="http://viewer.zmags.com/publication/2354d2e9?page=91"> 6 References 1. Enneking FK, Chan V, Greger J,</a> <a title="Sciatic Tutorial page 92" href="http://viewer.zmags.com/publication/2354d2e9?page=92"> 6 References 13. Taboada M, Rodriguez J, Bermu</a> <a title="Sciatic Tutorial page 93" href="http://viewer.zmags.com/publication/2354d2e9?page=93"> 25. Danelli G, Ghisi D, Fanelli A, et al. The eff</a> <a title="Sciatic Tutorial page 94" href="http://viewer.zmags.com/publication/2354d2e9?page=94"> Additional resources Additional resources relate</a> <a title="Sciatic Tutorial page 95" href="http://viewer.zmags.com/publication/2354d2e9?page=95"> Philips Healthcare is part of Royal Philips Elect</a>