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

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. 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. 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). Blocking the tibial and common peroneal nerves in the popliteal fossa separately provides for a faster onset than a prebifurcation sciatic block.