Ultrasound guided sciatic nerve block

Regional anesthesia is important in modern anesthesia practice and comprises a diverse group of anesthesia procedures including plexus and peripheral nerve blockade. Sciatic nerve blockade is a common regional anesthesia procedure used for lower limb surgery. The origin of the sciatic nerve is the sacral plexus, specifically from the lumbosacral trunk (ventral rami of L4-5) and the ventral rami of sacral nerves S1-S3. The sciatic nerve is the largest and longest nerve in the human body. The roots of the sciatic nerve can be identified in the pelvis (sacral plexus), and the nerve or its branches can be located in the gluteal region, posterior thigh, popliteal fossa and ankle. Therefore, sciatic nerve blockade can be potentially performed at many locations. Ultrasound (US) guidance provides a versatile technique for locating the nerve and performing sciatic nerve blockade. However, having a detailed knowledge of the anatomy of muscles, blood vessels and other non-neural structures related to the sciatic nerve throughout its course can assist in its location using US. Sciatic nerve blockade is a major regional anesthesia technique with a broad range of clinical and professional behaviors associated with its quality and success and therefore should only be performed after appropriate anesthesiology training. This chapter describes the relevant anatomy, sonoanatomy and technique options for blockade of the sciatic nerve and the overall quality and safety of this procedure.