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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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PEARLS

An increasing number of centers report an interest in popliteal nerve block. Extremely favorable reports emanate from the centers that have effectively incorporated this technique into busy foot and ankle surgical practices. As with many other lower extremity peripheral nerve blocks, the local anesthetic volume seems to be the key to making this block useful.

It also is apparent from watching many resident physicians perform this block that whenever the needle is initially misdirected it is directed too far medially. Usually all that is needed is to redirect the needle to a more lateral position. Finally, some groups are promoting a lateral approach to the popliteal block, and time will tell whether maintaining the patient in a supine position for this lateral technique can increase the interest of anesthesiologists in popliteal blocks.

The saphenous nerve block appears to require a larger volume of local anesthetic than many physicians use. Hence, one should be generous regarding the volume used with this block, keeping in mind that the popliteal block requires 30 to 40 mL of local anesthetic to produce a reliable block.

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