A Prospective, Randomized Comparison Between the Popliteal and Subgluteal Approaches for Continuous Sciatic Nerve Block with Stimulating Catheters

In Brief In this prospective, blinded study, we randomized 56 patients undergoing hallux valgus repair to receive continuous sciatic nerve block using a subgluteal (n = 28) or a posterior popliteal approach (n = 28) with a perineural stimulating catheter. Postoperatively, the stimulating catheter was connected to a patient-controlled analgesia pump with 0.0625% levobupivacaine (basal infusion rate of 3 mL/h, patient-controlled bolus dose of 3 mL, and lockout time of 20 min). Both approaches provided similar postoperative analgesia; however, local anesthetic consumption was larger in the popliteal group (4.9 ± 1.4 mL/h) compared with the subgluteal group (3.8 ± 1.1 mL/h; P < 0.05). We conclude continuous postoperative analgesia using stimulating catheters was effective at both injection sites; however, a subgluteal approach reduced the overall amount of local anesthetic. IMPLICATIONS: Comparison of two different continuous sciatic blocks with stimulating catheters demonstrated that the two approaches were effective; however, a larger volume of local anesthetic is necessary after the distal posterior popliteal approach as compared with the proximal subgluteal approach.