Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;63(8):635-639.
doi: 10.4103/ija.IJA_296_19.

Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients

B K Arjun  1 , R S Prijith  2 , G M Sreeraghu  2 , M C Narendrababu  2
Affiliations

Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients

B K Arjun et al. Indian J Anaesth. 2019 Aug.

Abstract

Background and aims: Central neuraxial block and general anaesthesia in patients with significant comorbidities are associated with considerable peri-operative morbidity and mortality. This study aims to delineate peripheral nerve block as a suitable alternative technique in high-risk patients posted for below-knee surgery.

Methods: Twenty patients with the American Society of Anesthesiologist's (ASA) physical status grade III and IV, aged 30-80 years, scheduled for below-knee surgery from May 2018 to February 2019 were enrolled in this prospective study. All patients received ultrasound-guided popliteal sciatic block with 20 ml 0.5% ropivacaine and adductor canal block with 10 ml 0.375% ropivacaine. The peripheral nerve block success rate, sensory and motor block onset time, haemodynamic parameters, duration of post-operative analgesia and patient's satisfaction were recorded. Descriptive statistics of the study were calculated and the data was analysed using an SPSS statistics 21.0 program.

Result: Surgery was performed successfully with no additional analgesic requirement in all patients. The mean duration for sensory and motor block onset time was 3.35 ± 0.49 (mean ± standard deviation) and 4.65 ± 0.48 (mean ± standard deviation) minutes respectively. Haemodynamic parameters were maintained stable throughout the procedure. The average duration of postoperative analgesia was 7.5 ± 0.8 (mean ± standard deviation) hours. Patient overall satisfaction as assessed, by three-point Lickert's scale, was satisfactory.

Conclusion: Ultrasound-guided combined popliteal sciatic and adductor canal block is an effective alternative anaesthetic technique for below-knee surgeries with stability of haemodynamic parameters and pain management in high-risk patients.

Keywords: Adductor canal; below-knee surgery; popliteal sciatic; ultrasound.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound image of adductor canal and ideal periarterial spread of local anaesthetic agent. FA- Femoral artery, FV- Femoral vein, VM- Vastus medialis, SA- Sartorius, AL- Adductor longus muscle
Figure 2
Figure 2
Ultrasound image of Sciatic nerve before bifurcation above the level of popliteal fossa and spread of local anaesthetic around the nerve following injection (Indicated by arrow). SN- Sciatic nerve, LA- local anaesthetic agent
See this image and copyright information in PMC

References

    1. Bech B, Melchiors J, Jensen K. The successful use of peripheral nerve blocks for femoral amputation. Acta Anaesthesiol Scand. 2009;53:257–60. - PubMed
    1. Chia N, Low TC, Poon KH. Peripheral nerve block for lower limb surgery-a choice of anaesthetic technique for patients with a recent myocardial infarction? Singapore Med J. 2002;43:583–6. - PubMed
    1. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound improves the success of sciatic nerve block at popliteal fossa. Reg Anesth Pain Med. 2008;33:259–65. - PubMed
    1. Latzke D, Marhofer P, Zeitlinger M, Machata A, Neumann F, Lackner E, et al. Minimal local anaesthetic volume for sciatic nerve blockade: Evaluation of ED99 in volunteers. Br J Anaesth. 2010;104:239–44. - PubMed
    1. Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118:1046–58. - PMC - PubMed