Popliteal Nerve Block

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  • Anesthesia for procedures on the distal tibia and fibula, ankle, and foot
  • Post-operative pain relief for procedures on the distal tibia and fibula, ankle, and foot
  • Absolute contraindications
    • Patient refusal
    • Allergy to local anesthetics
    • Infection at the site of insertion
  • Relative contraindications
    • Coagulopathy or systemic anticoagulation
    • Systemic infection
  • Standard anesthesia resuscitation equipment, including ECG, blood pressure and pulse oximetry monitors, suction, oxygen, and appropriate resuscitation drugs
  • Sterile mask and gloves
  • Sterile towels and gauze packs
  • Two, 20-mL syringes with stopcocks
  • Local anesthetic
  • Tuberculin syringe with 25-gauge needle for local infiltration
  • 22-gauge, 50 mm long, insulated stimulating needle
  • Nerve stimulator with electrode
  • Marking pen and ruler

The sciatic nerve is formed by the union of the first three sacral spinal nerves and the 4th and 5th lumbar nerves. It is the largest of the four major nerves supplying the leg. The sciatic nerve leaves the pelvis through the greater sciatic foramen. It runs toward the posterior aspect of the thigh between the greater trochanter of the femur and the ischial tuberosity. At 60 mm +/- 30 mm above the popliteal crease it divides into its terminal branches the tibial nerve (supplying the heel and sole of the foot) and the common peroneal (also known as the common fibular) nerve (innervating the lateral aspect of the leg and dorsum of the foot). The only aspect of the lower leg not innervated by the sciatic nerve is the medial aspect of the leg below the knee, which is supplied by the saphenous nerve.

On the posterior aspect of the knee, the landmarks for performance of the popliteal block are the tendons of the semimembranosus and semitendinosus muscles medially, the biceps femoris laterally, and the popliteal crease inferiorly.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Continue to monitor all vital signs, carefully observing for signs and symptoms of local anesthetic toxicity.
  • Patients routinely have these procedures as same-day admits or in day surgery, counsel patients about appropriate expected duration of block and adjunct pain medication to ensure optimization of pain control.
  • Counsel patients not to attempt to walk on the anesthetized limb to avoid injury due to falls, or soft tissue injury from direct trauma. Until the block is completely resolved, patients should ambulate only with support of an assistant or crutches.
  • Infection
  • Hematoma
  • Nerve damage due to direct neural injection or indirect ischemia of the nerve
  • Local anesthetic toxicity due to intravascular injection or delayed absorption of local anesthetic
  • Injury due to fall or direct trauma while trying to ambulate with the anesthetized limb
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