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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

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Partial Sciatic Nerve Ligation: A Mouse Model of Chronic Neuropathic Pain to Study the Antinociceptive Effect of Novel Therapies

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Published on: October 6, 2022

A novel approach for anterior sciatic nerve block: cadaveric feasibility study.

Aysun Uz¹, Nihal Apaydin, Surhan Ozer Cinar

¹Department of Anatomy, Ankara University School of Medicine, 06100, Sihhiye, Ankara, Turkey. uz@medicine.ankara.edu.tr

Surgical and Radiologic Anatomy : SRA

|March 6, 2010

Summary

A novel anterior approach for sciatic nerve block offers improved safety and efficacy. This technique allows for simultaneous femoral nerve blockade, enhancing anesthesia for the lower extremity.

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Area of Science:

Anatomy
Regional Anesthesia
Surgical Techniques

Background:

Sciatic nerve block is crucial for lower extremity anesthesia.
Traditional posterior and lateral approaches have limitations, including low success and high complication rates.
Anterior approaches are needed for specific patient positioning challenges.

Purpose of the Study:

To define a new, anatomically safe anterior approach for sciatic nerve block.
To assess the feasibility of simultaneously blocking the femoral nerve via the same anterior approach.

Main Methods:

Anatomical study involving measurements on 11 lower extremities.
Refinement of the anterior approach on 8 extremities.
Cadaveric injection of Indian ink into 2 extremities to evaluate needle path and potential injury.
Axial dissection of 1 extremity to confirm needle trajectory.

Main Results:

The optimal needle insertion point is 4-5 cm distal to the inguinal crease and 1-2 cm lateral to the femoral artery.
This location is approximately 8.0 ± 0.7 cm distal to a line between the ASIS and PT, with a lateral distance roughly half the length of this line.
Anatomical evaluation confirmed the safety of the approach regarding major neurovascular structures.

Conclusions:

The described anterior approach is anatomically safe for sciatic nerve block.
This technique potentially reduces the risk of neurovascular complications.
Simultaneous femoral nerve blockade is achievable, expanding the anesthetic coverage of the lower limb.