- Sciatic nerve pain
- Injuries (burns, lacerations, abscesses) of the posterior thigh
- 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.
- 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
Position the patient in the decubitus position with the leg flexed at the hip and knee flexed for comfort.
- Palpate the greater trochanter laterally and posterior iliac spine medially. Position the curvilinear transducer along this line.
- Identify the greater trochanter and ischial tuberosity under ultrasound guidance.
- Note that for this block; a much steeper angle of approach is required and your needle should likely enter at 60-70 degrees.
- Target local anesthetic spread around the sciatic nerve between the gluteus maximus and quadratus femoris muscle bellies.