Hindlimb unilateral Sciatic Nerve Block

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Regional Anesthesia
Peripheral Nerve Block
Sciatic Nerve Block

Indication

Anesthesia of the ipsilateral hindlimb distal to the mid femur. Suitable for example for knee surgery (TPLO, TTA), stifle arthroscopy and surgery of the tarsus (in combination with femoral and obturator nerve blocks)
Sciatic nerve block alone is sufficient for operations of the tarsus and paw

Step by step

Lateral position, limb to be blocked on top, placement of the linear array transducer in a dorsal plane just below the trochanter, needle insertion from caudal through the semitendinosus muscle in a cranial direction, "in plane"
Tibial and common peroneal nerve (yellow)
Lateral position, limb to be blocked on top, placement of the linear array transducer in a dorsal plane just below the trochanter, needle insertion from caudal through the semitendinosus muscle in a cranial direction, "in plane"
Tibial and common peroneal nerve (yellow)

Local anesthetics

Sciatic nerve block (Nerve stimulation/US)

Local anesthetics: Lidocain 2%, Mepivacain 2%, Bupivacain 0.5%, Ropivacain 0.75%
Initial setting NS: 0.5 mA, 2 Hz, 0.10 ms
Needle orientation: needle insertion from caudal through the semitendinosus muscle in a cranial direction, "in plane"
Muscle contraction: tarsus flexion and extension 
Reduction of the amperage: in small increments to <0.5 mA
Correction of the needle position: minor corrections only, pull back needle, correct angle, re-advance needle
MSC control: to avoid block failure
Aspiration and injection: slowly, Raj test, BSmart
Injection volume: 0.1 ml/kg
(Costa-Farre et al. 2011, Campoy et al. 2010)

Tibial and common peroneal nerve in sheath of connective tissue (arrow)

Videos

  • Sciatic nerve block (Nerve stimulation/US)

    Injection under ultrasound control into the perineural connective tissue

  • Sciatic nerve block (Nerve stimulation/US)

    Incorrect muscle response (M. biceps femoris / semitendinosus / semimembranosus)

  • Sciatic nerve block (Nerve stimulation/US)

    Correct muscle response (Cranial tibial muscle)

With the friendly assistance of
https://ktpraxis-berlin.de
Dr. Georg Papadopoulos
Veterinary Specialist for Small Animals
Additional Certification: Anesthesia in Small Animals
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Disclaimer

As with any intervention in the body, peripheral nerve blocks also carry the risk of complications. The presented procedures and dosages are thoroughly reviewed and based on currently available scientific data and clinical experience but should only be considered as guidelines along the contents of the course. The responsibility for performing the nerve blocks shown on this site as part of any anesthesia regimen or pain management lies with the executing clinician. B. Braun Vet Care GmbH and Dr. Papadopoulos cannot be held responsible for any complications or adverse effects, that may arise from the described techniques or for any mistakes in the information provided.