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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 16 – Popliteal and Saphenous Block

PERSPECTIVE

The nerves blocked in the popliteal fossa (i.e., tibial and peroneal nerves) are extensions of the sciatic nerve. The principal use of the popliteal block is for foot and ankle surgery. The addition of a saphenous nerve block provides improved comfort for many patients undergoing the popliteal block because medial lower leg and ankle sensory blockade make tourniquets and medial ankle surgery more comfortable.

Patient Selection.

To use the classic form of this block, the patient must be able to assume the prone position. Although elicitation of a paresthesia or motor response is desirable, it is not essential, and block effectiveness decreases without these endpoints.

Pharmacologic Choice.

The principal use of these blocks is to provide sensory analgesia; thus, lower concentrations of a local anesthetic are practical, in contrast to situations in which motor blockade is essential. Concentrations of 1% lidocaine, 1% mepivacaine, 0.25% to 0.5% bupivacaine, and 0.2% to 0.5% ropivacaine are effective.

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