Ultrasound-Guided Single-Penetration Block for Sciatic and Saphenous Nerve Versus The Traditional Double Penetration Popliteal- Sciatic/Saphenous Technique for Leg and Foot Surgery

Abstract

Abstract Background A new approach is described to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. Aim of the Study The aim of this work is to compare between the new single-penetration block technique for block of the SCN and SAN at proximal thigh and the traditional popliteal sciatic nerve block at popliteal fossa with saphenous nerve block at adductor canal technique for leg and foot surgery. Subjects and Methods This prospective single blinded randomized parallel group study was conducted to compare between the ultrasound guided single penetration block technique for sciatic and saphenous nerve at proximal thigh to the traditional popliteal sciatic nerve block at popliteal fossa and saphenous block at adductor canal. Results Performance time was significantly faster with the single penetration technique median time 6.33 minutes (range, 3-10 minutes) versus 12.57 minutes (range from 8-20 minutes) (P < 0.001), respectively Positioning time was also significantly shorter with the single penetration block technique compared to the traditional block combination technique that is median time 0 minutes (range, 0-0 minutes) versus median time 5.78 minutes (range 3-10 minutes) (P < 0.001), respectively. No other statistically significant differences were recorded. Conclusions The single penetration block resulted in significantly faster performance time and reduced positioning time with statistically equal efficacy in relation to pain assessment, nausea, meperdin demand, dermatomal anesthesia, and motor blockade. The single penetration block is statistically an equally effective alternative to the traditional popliteal-sciatic/saphenous block combination for leg and foot surgery, but it is faster, requires only 1 skin penetration, and does not require repositioning of the leg.