Source: Benedetto et al. Anesth Analg 2001; 93: 1040-4

Reviewer:  R. Prasad, MD

Summary:

• Subgluteas approach faster, more comfortable, equally efficacious

• It's another approach to know, that may be useful in some cases (very obese patients?)
• However, I wouldn't expect their approach to block the Post. Fem Cutan Nerve, so functionally the popliteal block may be just as good

• 12 pts for orthopedic foot surgery
• 64 Classic, 64 Subgluteus. Subgluteus technique:
• Lateral position
• Draw line from greater trochanter to ischial tuberosity (=#1)
• Extend perpendicular from midpoint of #1, 4 cm caudally (=#2)
• #2 identifies the "sciatic line" - course of sciatic nerve in sulcus btwn biceps femoris and semitendinosus muscles
• Needle inserted perpendicular to skin at end of #2.
• Injected 20cc 0.75% ropiv after twitch at < 0.5mA.
• Recorded time to complete block, depth of needle, number of changes in needle direction, adequacy of block, comfort during block

Discussion:

• Increased discomfort prob due to shallower depth, and reduced number of needle passes
• Observer evaluating blocks, and intraop efficacy, was not blinded to approach used - possible bias.