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Related Experiment Video

Updated: Jan 24, 2026

Preparation of Rat Sciatic Nerve for Ex Vivo Neurophysiology
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Subparaneural Injection in Popliteal Sciatic Nerve Blocks Evaluated by MRI.

Benedikt Büttner1, Alexander Schwarz2, Caspar Mewes1

  • 1Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany.

Open Medicine (Warsaw, Poland)
|June 4, 2019
PubMed
Summary

Subparaneural injection during sciatic nerve blocks is often misidentified as intraneural. Despite appearing intraneural, these injections rarely cause nerve damage, explaining the lack of neurological sequelae in patients.

Keywords:
Intraneural injectionMagnetic resonance imagingPopliteal sciatic nerve blockSubparaneural injectionUltrasound-guidance

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Area of Science:

  • Anesthesiology
  • Neuroimaging
  • Regional Anesthesia

Background:

  • Intraneural injection of local anesthetics can cause nerve damage.
  • Frequent intraneural injections during sciatic nerve blocks often lack neurological sequelae, creating controversy.
  • The anatomy of the sciatic nerve and its paraneural sheath influences needle tip placement and injection spread.

Purpose of the Study:

  • To investigate the actual intraneural extent of subparaneural injections during popliteal sciatic nerve blocks.
  • To correlate sonographic findings with magnetic resonance imaging (MRI) for precise assessment of injection spread.
  • To clarify the discrepancy between observed intraneural injections and the absence of neurological deficits.

Main Methods:

  • Ultrasound guidance for needle tip positioning and local anesthetic injection in the subparaneural space.
  • Sonography and MRI to evaluate the spread of the injected local anesthetic.
  • Inclusion of 22 patients undergoing lower extremity surgery requiring popliteal sciatic nerve block.

Main Results:

  • The sciatic nerve cross-sectional area significantly increased post-injection (57.8 mm² to 110.8 mm²).
  • Sonographic evidence of intraneural injection was observed in 21 out of 22 patients.
  • Only two patients showed sonographic evidence of intrafascicular injection, confirmed by MRI in one case, with no reported neurological symptoms.

Conclusions:

  • Subparaneural injection in the popliteal sciatic nerve is infrequently truly intraneural (intrafascicular).
  • The common sonographic appearance of intraneural injection may not equate to intrafascicular needle placement.
  • This finding helps explain the frequent lack of neurological sequelae despite apparent intraneural injections during sciatic nerve blocks.