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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 12 – Sciatic Block

PERSPECTIVE

The sciatic nerve is one of the largest nerve trunks in the body, yet few surgical procedures can be performed with sciatic block alone. It is most often combined with femoral, lateral femoral cutaneous, and/or obturator nerve blocks to produce surgical anesthesia of the lower leg. The block is also effective for analgesia of the lower leg and may provide pain relief from ankle fractures or tibial fractures prior to operative intervention.

Patient Selection.

The sciatic block may be indicated for patients needing analgesia before transport for definitive orthopedic surgical repair of lower leg or ankle fractures. There also may be patients in whom it is desirable to avoid the sympathectomy accompanying neuraxial block, and in these patients sciatic block combined with femoral nerve block often allows ankle and foot procedures to be carried out. Another group of patients in whom this block is often useful are those undergoing distal amputations of the lower extremity who have vascular compromise due to diabetes or peripheral vascular disease.

Pharmacologic Choice.

Sciatic nerve block requires 20 to 25 mL of local anesthetic solution. When this volume is added to that required for other lower extremity peripheral blocks, the total may reach the upper end of an acceptable local anesthetic dose range. Conversely, uptake of local anesthetic from these lower extremity sites is not as rapid as with epidural or intercostal block; thus, a larger mass of local anesthetic may be appropriate in this region. If motor blockade is desired with this block, 1.5% mepivacaine or lidocaine may be necessary, whereas 0.5% bupivacaine or 0.5% to 0.75% ropivacaine alone is effective.

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