Transgluteal Sciatic

by | Dec 7, 2023

Indications

  • Sciatic nerve pain
  • Injuries (burns, lacerations, abscesses) of the posterior thigh

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic
  • Concern for compartment syndrome
  • Approximately 6% risk of foot drop, the patient should be made aware and encouraged not to drive for the duration of the block.

Equipment

  • 10-20cc of local anesthetic of choice
    • Optional: Can add 4-8mg of dexamethasone
  • 20-22G 8-10cm Quincke or echogenic block needle
  • Cleansing solution
  • Ultrasound with low-frequency curvilinear probe
  • Ultrasound transducer sterile cover

Ultrasound

Position

Position the patient in the decubitus position with the leg flexed at the hip and knee flexed for comfort.

Ultrasound

Palpate the greater trochanter laterally and posterior iliac spine medially. Position the curvilinear transducer along this line.

Technique

  1. Palpate the greater trochanter laterally and posterior iliac spine medially. Position the curvilinear transducer along this line.
  2. Identify the greater trochanter and ischial tuberosity under ultrasound guidance.
  3. Note that for this block; a much steeper angle of approach is required and your needle should likely enter at 60-70 degrees.
  4. Target local anesthetic spread around the sciatic nerve between the gluteus maximus and quadratus femoris muscle bellies.

Examples

Source

  1. The POCUS Atlas