Popliteal Sciatic

by | Aug 24, 2021

Indications

  • Fractures of distal tibia/fibula, foot fractures
  • Achilles tendon rupture
  • Lower extremity burns, lacerations and abscesses

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic
  • Request of consultant
  • Concern for compartment syndrome

Equipment

  • 15-20cc of local anesthetic of choice
  • 20-22G needle
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover

Ultrasound

Position

Position the patient prone

Ultrasound

Landmarks

  1. Place the transducer in a transverse orientation in the popliteal fossa
  2. Identify the popliteal artery and vein

  1. Translate cephalad to observe the common peroneal nerve and tibial nerve joining to form the distal sciatic nerve

Technique

  1. Introduce needle lateral to medial
  2. In-plane needle visualization aided by flat angle-of-entry
  3. Gently inject local anesthetic around the nerve bundle

Examples

Needle entering from the lateral aspect (screen right) and depositing anesthetic just deep to the fascia iliaca (*) which lies deep to the sartorius muscle and superficial to the iliacus muscle.

 

Source

  1. The POCUS Atlas
  2. Highland Ultrasound
  3. WikEM