Crosswise approach to the popliteal sciatic nerve block

Background

The ultrasound guided popliteal sciatic block is a nerve block commonly used for pain control in the setting of distal tibia and/or fibular fractures, ankle reductions, Achilles tendon ruptures, and injuries to the lateral/posterior calf (burns, abscesses, or lacerations. In the Emergency Department, this block is classically performed by positioning the patient in a lateral or prone position. Unfortunately, in the acute setting, patient repositioning is often not possible secondary to pain, limiting the use of this block. In this case series, we describe a novel approach to the popliteal sciatic nerve block that allows the patient to remain in the supine position and enter from a crosswise approach.

Case report

This paper describes three cases, all which have painful complaints in the distribution of the popliteal sciatic nerve. In the first case, the patient has a bimalleolar ankle fracture. In the second, the patient has second degree burns that get contaminated and need decontamination. In the third, the patient has an unstable ankle fracture but will not accept opiates. In each, the presentation limits the provider’s ability to reposition the patient therefore this novel, crosswise approach to the popliteal sciatic nerve block allows optimal care without painful repositioning.

Why should an emergency physician be aware of this?

While further research is still needed on the crosswise approach to the popliteal sciatic nerve block, it offers a novel approach to this classic block without the need for patient repositioning.