The course of the sciatic nerve in the gluteal region and comparison of two methods used for sciatic nerve blockage

Year 2022, Volume: 16 Issue: 1, 19 - 25, 20.04.2022

Bilge İpek Torun Ayşe Surhan Çınar Luis Filgueira Shane R. Tubbs Alparslan Apan Aysun Uz

Abstract

Objectives: The aim of this study was to reevaluate the anatomy of the sciatic nerve (SN) in the gluteal region by identifying reliable landmarks in order to suggest a safe insertion point for SN blockage (SNB), and to compare two methods used for SNB.
Methods: Bilateral dissections of the SN were performed on ten embalmed cadavers. The course of the SN in relation to a line drawn between the posterior superior iliac spine (PSIS) and the ischial tuberosity (IT) was determined. The files of 100 patients, 50 of whom had SNB with the Labat’s method (group L) and 50 with the parasacral approach (group P), were reviewed retrospectively. The results of the two methods were compared.
Results: The vertical distance between the PSIS to the IT was 13.1±6.5cm. The vertical distance between the intersection points of the inferior border of the piriformis with the medial and lateral margins of the SN were 7.8±0.7 and 9.1±0.6 cm, respectively. Medial and lateral margins of the SN were found to be 1.8±0.5 and 2.9±0.6 cm lateral to the IT. Insertion depth of the needle and time for the intervention were similar for both of the methods, but need for additional nerve blockages were significantly higher in group L than in group P.
Conclusion: We defined a safe insertion point for SNB in the gluteal region, using prominent, fixed bony and easily detectable landmarks. The clinical results of both groups were similar, but need for additional nerve blockages were significantly higher in group L.

Keywords

anatomical landmark, postoperative pain, regional anesthesia, sciatic blockage, gluteal region

References

• Beck GP. Anterior approach to sciatic nerve block. Anesthesiology 1963;24:222–4.
• Guardini R, Waldron BA, Wallace WA. Sciatic nerve block: a new lateral approach. Acta Anaesthesiol Scand 1985;29:515–9.
• Raj PP, Parks RI, Watson TD, Jenkins MT. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg 1975;54:489–93.
• Waldman SD. Comprehensive atlas of ultrasound-guided pain management injection techniques. Philadelphia (PA): Wolters Kluwer; 2013. 1205 p.
• Mansour NY. Reevaluating the sciatic nerve block: another landmark for consideration. Reg Anesth 1993;18:322–3.
• Sites BD, Chan VW, Neal JM, Weller R, Grau T, Koscielniak-Nielsen ZJ, Ivani G. The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2010;35:S74–80.
• Wegener JT, van Doorn CT, Eshuis JH, Hollmann MW, Preckel B, Stevens MF. Value of an electronic tutorial for image interpretation in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2013;38:44–9.
• Moore KL, Dalley AF, AMR A. Lower limb. In: Moore KL, Dalley AF, AMR A, editors. Clinically oriented anatomy. Baltimore: Wolters Kluwer Press; 2018. p. 734.
• Cuvillon P, Ripart J, Jeannes P, Mahamat A, Boisson C, L'Hermite J, Vernes E, de la Coussaye JM. Comparison of the parasacral approach and the posterior approach, with single- and double-injection techniques, to block the sciatic nerve. Anesthesiology 2003;98:1436–41.
• di Benedetto P, Bertini L, Casati A, Borghi B, Albertin A, Fanelli G. A new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach. Anesth Analg 2001;93:1040–4.
• Sukhani R, Candido KD, Doty Jr R, Yaghmour E, McCarthy RJ. Infragluteal-parabiceps sciatic nerve block: an evaluation of a novel approach using a single-injection technique. Anesth Analg 2003;96:868–73.
• Ericksen ML, Swenson JD, Pace NL. The anatomic relationship of the sciatic nerve to the lesser trochanter: implications for anterior sciatic nerve block. Anesth Analg 2002;95:1071–4.
• Vloka JD, Hadziç A, April E, Thys DM. Anterior approach to the sciatic nerve block: the effects of leg rotation. Anesth Analg 2001;92:460–2.
• Van Elstraete AC, Poey C, Lebrun T, Pastureau F. New landmarks for the anterior approach to the sciatic nerve block: imaging and clinical study. Anesth Analg 2002;95:214–8.
• Le Corroller T, Wittenberg R, Pauly V, Pirro N, Champsaur P, Chouet O. A new lateral approach to the parasacral sciatic nerve block: an anatomical study. Surg Radiol Anat 2011;33:91–5.
• Uz A, Apaydin N, Cinar SO, Apan A, Comert B, Tubbs RS, Loukas M. A novel approach for anterior sciatic nerve block: cadaveric feasibility study. Surg Radiol Anat 2010;32:873–8.
• Kim TE, Tsui BCH. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents. Korean J Anesth 2019;72:13–23.