Ultrasound-Guided Sciatic Nerve Block in the Popliteal Fossa Using a Lateral Approach: Onset Time Comparing Separate Tibial and Common Peroneal Nerve Injections Versus Injecting Proximal to the Bifurcation

BACKGROUND: We hypothesized that blocking the tibial and common peroneal nerves individually using ultrasound distal to sciatic bifurcation would decrease time to complete block compared with a block proximal to the bifurcation. METHODS: Seventy-six patients undergoing foot or ankle surgery received a sciatic nerve block either proximal or distal to the point of bifurcation. A mixture of 28 mL 1.5% mepivacaine with 100 microg clonidine and 1 mL 8.4% sodium bicarbonate for a total of 30 mL was used. Ultrasound was used to guide needle adjustments to achieve circumferential spread. Block success was defined as a loss of sensation to pinprick in both nerve distributions within 46 minutes. RESULTS: Patients in the tibial-peroneal group had significantly faster time to complete block than the sciatic group (19.2 vs 26.1 minutes; P = 0.006). CONCLUSIONS: Blocking the tibial and common peroneal nerves in the popliteal fossa separately provides for a faster onset than a prebifurcation sciatic block.