Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 2nd

19. Sciatic Block


General Considerations

The posterior approach to sciatic nerve block has wide clinical applicability for surgery and pain management of the lower extremity. Consequently, a sciatic block is one of the more commonly used techniques in our practice. In contrast to a common belief, this block is relatively easy to perform and associated with a high success rate. It is particularly well-suited for surgery on the knee, calf, Achilles tendon, ankle, and foot. It provides complete anesthesia of the leg below the knee with the exception of the medial strip of skin, which is innervated by the saphenous nerve. When combined with a femoral nerve or lumbar plexus block, anesthesia of the entire lower extremity can be achieved.

Functional Anatomy

The sciatic nerve is formed from the L4 through S3 roots. These roots form the sacral plexus on the anterior surface of the lateral sacrum and converge to become the sciatic nerve on the anterior surface of the piriformis muscle. The sciatic nerve is the largest nerve in the body and measures nearly 2 cm in breadth at its origin. The course of the nerve can be estimated by drawing a line on the back of the thigh beginning from the apex of the popliteal fossa to the midpoint of the line joining the ischial tuberosity to the apex of the greater trochanter. The sciatic nerve also gives off numerous articular (hip, knee) and muscular branches.

The sciatic nerve exits the pelvis through the greater sciatic foramen below the piriformis and descends between the greater trochanter of the femur and the ischial tuberosity, superficial to the external rotators of the hip (obturator internus, the gemelli muscles, and quadratus femoris) (Figures 19.1-2 and 19.1-3). On its medial side, the sciatic nerve is accompanied by the posterior cutaneous nerve of the thigh and the inferior gluteal artery. The articular branches of the sciatic nerve arise from the upper part of the nerve and supply the hip joint by perforating the posterior part of its capsule. Occasionally, these branches are derived directly from the sacral plexus. The muscular branches of the sciatic nerve are distributed to the biceps femoris, semitendinosus, and semimembranosus muscles, and to the ischial head of the adductor magnus. The two components of the nerve (tibial and common peroneal) diverge approximately 4 to 10 cm above the popliteal crease to separately continue their paths into the lower leg.


FIGURE 19.1-2. The course and motor innervation of the sciatic nerve.


FIGURE 19.1-3. Anatomy of the sciatic nerve at the subgluteal location. Image sciatic nerve. Image nerve branch to the gluteus muscle. Image ischial bone. Image greater trochanter. Image posterior superior iliac spine. Image gluteus muscle.


• There are numerous variations in the course of the sciatic nerve through the gluteal region. In about 15% of the population, the piriformis muscle divides the nerve. The common peroneal component passes through or above the muscle, and the tibial component passes below it.

• The components of the sciatic nerve diverge at a variable distance from the knee joint. By and large, most nerves diverge at 4 to 10 cm above the popliteal fossa crease.

Distribution of Blockade

A sciatic nerve block results in anesthesia of the skin of the posterior aspect of the thigh, hamstring, and biceps femoris muscles; part of the hip and knee joint; and the entire leg below the knee with the exception of the skin of the medial aspect of the lower leg (Figure 19.1-4). Depending on the level of surgery, the addition of a saphenous or femoral nerve block may be required to provide coverage for this area.


FIGURE 19.1-4. Sensory innervation of sciatic nerve and its terminal branches.

Single-Injection Sciatic Nerve Block


A standard regional anesthesia tray is prepared with the following equipment:

• Sterile towels and gauze packs

• One 20-mL syringe containing local anesthetic

• A 3- to 5-mL syringe plus 25-gauge needle with local anesthetic for skin infiltration

• A 10-cm, 21-22 gauge short-bevel insulated stimulating needle

• Peripheral nerve stimulator

• Sterile gloves; marking pen

Landmarks and Patient Positioning

The patient is in the lateral decubitus position tilted slightly forward (Figure 19.1-5). The foot on the side to be blocked should be positioned over the dependent leg so that elicited motor response of the foot or toes can be easily observed.


FIGURE 19.1-5. The patient is positioned in a lateral oblique position with the dependent leg extended and the leg to be blocked flexed in the knee.


• The skin over the gluteal area is easily movable. Therefore, it is important that the patient remains in the same position in which the landmarks are outlined. A small forward or backward tilt of the pelvis can result in a significant shift of the landmarks, leading to difficulty localizing the sciatic nerve.

Landmarks for the posterior approach to a sciatic blockade are easily identified in most patients. A proper palpation technique is important to adhere to because the adipose tissue over the gluteal area can obscure these bony prominences. The landmarks are outlined with a marking pen:

1. Greater trochanter (Figure 19.1-6)


FIGURE 19.1-6. Palpation technique for the greater trochanter.

2. Posterior superior iliac spine (PSIS) (Figure 19.1-7)


FIGURE 19.1-7. Palpation technique for posterior superior iliac spine.

3. Needle insertion point 4 cm distal to the midpoint between landmarks 1 and 2 (Figure 19.1-8)


FIGURE 19.1-8. The needle insertion site is marked 5 cm posterior on the line passing through the midpoint between the greater trochanter 1 and the posterior superior iliac spine 2.

A line between the greater trochanter and the PSIS is drawn and divided in half. Another line passing through the midpoint of this line and perpendicular to it is extended 4 cm caudal and marked as the needle insertion point.


• Palpating the greater trochanter: The osseous prominence of the greater trochanter is best approached from its posterior aspect, Figure 19.1-6.

• Palpating the PSIS: The palpating hand is rolled back from the greater trochanter until the fingers meet the osseous PSIS. This landmark should be labeled on the side facing the great trochanter, Figure 19.1-7.

• Identifying the “inner” aspects of the greater trochanter and the posterior-superior iliac spine results in a shorter line connecting the two and a more accurate approximation of the position of the sciatic nerve.


After skin disinfection, local anesthetic is infiltrated subcutaneously at the needle insertion site. The operator should assume an ergonomic position to allow precise needle maneuvering and monitoring of the responses to nerve stimulation.

The fingers of the palpating hand should be firmly pressed on the gluteus area to decrease the skin to nerve distance. Also, the skin between the index and middle fingers should be stretched to allow greater precision during block placement (Figure 19.1-9). The palpating hand should not be moved during the entire procedure. Even small movements of the palpating hand can change the position of the needle insertion site because of the highly movable skin and soft tissues in the gluteal region. The needle is introduced perpendicular to the spherical skin plane. Initially, the nerve stimulator should be set to deliver a current intensity of 1.5 mA to allow for the detection of both twitches of the gluteal muscles as the needle passes through tissue layers and stimulation of the sciatic nerve.


FIGURE 19.1-9. Needle insertion for the transgluteal (posterior) approach to sciatic nerve block.

As the needle is advanced, twitches of the gluteal muscles are observed first. These twitches merely indicate the needle position is still too shallow. Once the gluteal twitches disappear, brisk response of the sciatic nerve ensues (hamstring, calf, foot, or toe twitches). After an initial stimulation of the sciatic nerve is obtained, the stimulating current is gradually decreased until twitches are still seen or felt at 0.2 to 0.5 mA. Typically, this occurs at a depth of 5 to 8 cm. At this low current intensity, any observed motor response is from the stimulation of the sciatic nerve, rather than direct muscle stimulation (false twitch). After negative aspiration for blood, 15 to 20 mL of local anesthetic is injected slowly. Any resistance to the injection of local anesthetic should prompt cessation of the injection and withdrawal of the needle by 1 mm before reattempting to inject. Persistent resistance to injection should prompt complete needle withdrawal and flushing to ensure the patency of the needle before reattempting the procedure.


The aim is to obtain visible or palpable twitches of the hamstrings, calf muscles, foot, or toes at 0.2 to 0.5 mA. Twitches of the hamstring are equally acceptable with the transgluteal approach because level of the block is proximal to the departure of the nerve branches to the hamstring muscle.


Table 19.1-1 lists some common responses to nerve stimulation and the course of action to take to obtain the proper response.

TABLE 19.1-1 Some Common Responses to Nerve Stimulation and Course of Action for Proper Response



• Stimulation at a current intensity <0.5 mA may not be possible in some patients. This may occur in elderly patients and in patients with long-standing diabetes mellitus, peripheral neuropathy, sepsis, or severe peripheral vascular disease. In these cases, stimulating currents up to 1.0 mA should be accepted as long as the motor response is distal, specific and clearly seen or felt.

• We do not advise to use epinephrine in sciatic nerve blockade because of the possibility of ischemia of the sciatic nerve that could result due to the combination of stretching or sitting on the anesthetized nerve and the long duration of blockade.

Block Dynamics and Perioperative Management

This technique may be associated with patient discomfort because the needle passes through the gluteus muscles. Adequate sedation and analgesia are important to ensure the patient is still and tranquil. Typically, we use midazolam 2 to 4 mg after the patient is positioned and alfentanil 500 to 750 μg just before the needle is inserted. A typical onset time for this block is 10 to 25 minutes, depending on the type, concentration, and volume of local anesthetic used. The first signs of onset of the blockade are usually a report by the patient that the foot “feels different” or an inability to wiggle the toes.


• Inadequate skin anesthesia despite an apparently timely onset of the blockade can occur. It can take 30 minutes or more for full sensory-motor anesthesia to develop. However, local infiltration by the surgeon at the site of the incision is often all that is needed to allow the surgery to proceed until the block fully sets up.

Continuous Sciatic Nerve Block

Adequate experience with the single-injection technique is necessary to ensure efficacy and safety of the continuous block. The procedure is quite similar to the single-injection procedure; however, a slight angulation of the needle caudally is necessary after obtaining the nerve response to facilitate threading of the catheter. This technique can be used for surgery and postoperative pain management in patients undergoing a wide variety of lower leg, foot, and ankle surgeries. In our practice, perhaps the single most important indication for use of this block is for amputation of the lower extremity.


A standard regional anesthesia tray is prepared with the following equipment:

• Sterile towels and gauze packs

• One 20-mL syringe containing local anesthetic

• Sterile gloves, marking pen, and surface electrode

• A 3- to 5-mL syringe plus 25-gauge needle with local anesthetic for skin infiltration

• Peripheral nerve stimulator

• Catheter kit (including an 8- to 10-cm large-gauge stimulating needle and catheter)

Kits come in two varieties based on catheter construction: nonstimulating (conventional) and stimulating catheters. During the placement of a nonstimulating catheter, the needle is advanced first until appropriate twitches are obtained. Then 5 to 10 mL of local anesthetic or other injectate (e.g., D5W) is injected to “open up” a space for the catheter to facilitate its insertion. The catheter is threaded through the needle until approximately 3 to 5 cm is protruding beyond the tip of the needle. The needle is withdrawn, the catheter secured, and the remaining local anesthetic is injected via the catheter. Stimulatingcatheters are insulated and have a filament or core that transmits current to a bare metal tip. After obtaining twitches via the needle, the catheter is advanced with the nerve stimulator guidance while the motor response of the foot, calf, or toes is maintained. With the catheter technique, motor response of ≤1.0 mA is adequate. If the motor response is lost, the catheter can be withdrawn until it reappears, and the catheter is then readvanced while maintaining the response. This method requires that only nonconducting solution be injected through the needle (e.g., dextrose) prior to catheter advancement.

Landmarks and Patient Positioning

Proper patient positioning at the outset and maintenance of this position during performance of a continuous sciatic nerve blockade is crucial for precise catheter placement.

The patient is placed in the lateral decubitus position similar to the single-injection block. A slightly forward pelvic tilt prevents “sagging” of the soft tissues in the gluteal area and significantly facilitates block placement.

The landmarks for a continuous sciatic block are the same as those in the single-injection technique (Figure 19.1-8):

1. Greater trochanter

2. Posterior superior iliac spine

3. Needle insertion site 4 cm caudal to the midpoint of the line between landmarks 1 and 2


The continuous sciatic block technique is similar to the single-injection technique. With the patient in the lateral decubitus position and tilted slightly forward, the landmarks are identified and marked with the pen. After a thorough cleaning of the area with an antiseptic solution, the skin at the needle insertion site is infiltrated with local anesthetic. The palpating hand is positioned and fixed around the site of needle insertion to shorten the skin to nerve distance.

A 10-cm continuous block needle is connected to the nerve stimulator and inserted perpendicularly to the skin (Figure 19.1-10). The initial intensity of the stimulating current should be 1.0 to 1.5 mA.


FIGURE 19.1-10. Insertion of the catheter for continuous sciatic nerve block.


• It is useful to inject some local anesthetic intramuscularly to prevent pain during advancement of the needle.

• When a stimulating catheter is used, motor response at a current intensity ≤1.0 mA is adequate.

As the needle is advanced, twitches of the gluteus muscle are observed first. Deeper needle advancement results in stimulation of the sciatic nerve. The principles of nerve stimulation and needle redirection are identical to those for the single-injection technique. After obtaining the appropriate twitches, the needle is manipulated until the desired response (twitches of the hamstrings muscles or foot) is seen or felt using a current of 0.5-1.0 mA. The catheter should be advanced 3-5 cm beyond the needle tip. The needle is withdrawn back to the skin level, and the catheter advanced simultaneously to prevent inadvertent removal of the catheter.

The catheter is checked for inadvertent intravascular placement and secured to the buttock using an adhesive skin preparation such as benzoin or Dermabond, followed by application of a clear occlusive dressing. The infusion port should be clearly marked “continuous nerve block.”


• When insertion of the catheter proves difficult, lowering the angle of the needle can be helpful.

Continuous Infusion

Continuous infusion is always initiated after administration of an initial bolus of dilute local anesthetic through the needle or catheter. For this purpose, we routinely use 0.2% ropivacaine 15 to 20 mL. Diluted bupivacaine or levobupivacaine are suitable but can result in more pronounced motor blockade. The infusion is maintained at 5 to 10 mL/h when a patient-controlled regional analgesic dose (5 mL every 60 minutes) is planned.


• Breakthrough pain in patients undergoing a continuous infusion is always managed by administering a bolus of local anesthetic. Simply increasing the rate of infusion is never adequate.

• For patients on the ward, a higher concentration of a shorter acting local anesthetic (e.g., 1% lidocaine) is useful both to treat the pain quickly and to test the position of the catheter.

• When the bolus injection through the catheter fails to result in blockade after 30 minutes, the catheter should be considered dislodged and should be removed.

Complications and How to Avoid Them

Table 19.1-2 lists some general and specific instructions on possible complications and methods used to avoid them.


TABLE 19.1-2 Complications of Sciatic Nerve Block and Preventive Techniques



Altermatt F, Cortinez LI, Munoz H. Plasma levels of levobupivacaine after combined posterior lumbar plexus and sciatic nerve blocks. Anesth Analg. 2006;102(5):1597.

Bailey SL, et al. Sciatic nerve block. A comparison of single versus double injection technique. Reg Anesth. 1994;19(1):9-13.

Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg. 2004;98(3):747-749.

Bridenbaugh PO, Wedel DJ. The lower extremity: somatic blockade. In: Cousins MJ, Bridenbaugh PO, eds. Neuronal Blockade in Clinical Anesthesia and Management of Pain. 3rd ed. Philadelphia, PA: Lippincott-Raven; 1998:375–394.

Brummett CM, et al. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 2009;111(5):1111-1119.

Candido KD, Sukhani R, McCarthy RJ. Posterior approach to the sciatic nerve: can “common sense” replace science and logic? Anesthesiology. 2003;99(5):1237-1238.

Capdevila X, Ponrouch M, Choquet O. Continuous peripheral nerve blocks in clinical practice. Curr Opin Anaesthesiol. 2008;21(5):619-623.

Casati A, et al. A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesth Analg. 2002;94(4):987-990.

Casati A, et al. Levobupivacaine 0.2% or 0.125% for continuous sciatic nerve block: a prospective, randomized, double-blind comparison with 0.2% ropivacaine. Anesth Analg. 2004;99(3):919-923.

Casati A, et al. Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters. Anesth Analg. 2005;101(4):1192-1197.

Chan VW, et al. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology. 2006; 104(2):309-314.

Crabtree EC, et al. A method to estimate the depth of the sciatic nerve during subgluteal block by using thigh diameter as a guide. Reg Anesth Pain Med. 2006;31(4):358-362.

Cuvillon P, et al. Comparison of the parasacral approach and the posterior approach, with single- and double-injection techniques, to block the sciatic nerve. Anesthesiology. 2003;98(6):1436-1441.

Dalens B, Tanguy A, Vanneuville G. Sciatic nerve blocks in children: comparison of the posterior, anterior, and lateral approaches in 180 pediatric patients. Anesth Analg. 1990;70(2):131-137.

Danelli G, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia. 2009;64(6):638-642.

di Benedetto P, et al. A new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach. Anesth Analg. 2001;93(4):1040-1044.

di Benedetto P, et al. Postoperative analgesia with continuous sciatic nerve block after foot surgery: a prospective, randomized comparison between the popliteal and subgluteal approaches. Anesth Analg. 2002;94(4):996–1000.

di Benedetto P, et al. Continuous sciatic nerve block: how to choose among different proximal approaches? Gluteal or subgluteal continuous sciatic nerve block. Anesth Analg. 2003;97(1):296-297.

di Benedetto P, Casati A, Bertini L. Continuous subgluteus sciatic nerve block after orthopedic foot and ankle surgery: comparison of two infusion techniques. Reg Anesth Pain Med. 2002;27(2): 168-172.

Ericksen ML, Swenson JD, Pace NL. The anatomic relationship of the sciatic nerve to the lesser trochanter: implications for anterior sciatic nerve block. Anesth Analg. 2002;95(4):1071-1074.

Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine. Can J Anaesth. 1994;41(6):486-491.

Floch H, et al. Computed tomography scanning of the sciatic nerve posterior to the femur: practical implications for the lateral midfemoral block. Reg Anesth Pain Med. 2003;28(5):445-449.

Fournier R, et al. Levobupivacaine 0.5% provides longer analgesia after sciatic nerve block using the Labat approach than the same dose of ropivacaine in foot and ankle surgery. Anesth Analg. 2010;110(5):1486-1489.

Franco CD. Posterior approach to the sciatic nerve in adults: is euclidean geometry still necessary? Anesthesiology. 2003;98(3):723-728.

Franco CD, et al. A subgluteal approach to the sciatic nerve in adults at 10 cm from the midline. Reg Anesth Pain Med. 2006;31(3):215-220.

Franco CD, Tyler SG. Modified subgluteal approach to the sciatic nerve. Anesth Analg. 2003;97(4):1197.

Fuzier R, et al. Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery? Anesth Analg. 2005;100(5):1511-1514.

Gaertner E, et al. Continuous parasacral sciatic block: a radiographic study. Anesth Analg. 2004;98(3):831-834; table of contents.

Hadžić A, et al. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anesth Pain Med. 1998;23(3):241-246.

Hagon BS, et al. Parasacral sciatic nerve block: does the elicited motor response predict the success rate? Anesth Analg. 2007;105(1):263-266.

Hanks RK, et al. The effect of age on sciatic nerve block duration. Anesth Analg. 2006;102(2):588-592.

Helayel PE, et al. Urinary incontinence after bilateral parasacral sciatic-nerve block: report of two cases. Reg Anesth Pain Med. 2006;31(4):368-371.

Jochum D, et al. Adding a selective obturator nerve block to the parasacral sciatic nerve block: an evaluation. Anesth Analg. 2004;99(5):1544-1549.

Kilpatrick AW, Coventry DM, Todd JG. A comparison of two approaches to sciatic nerve block. Anaesthesia. 1992;47(2):155-157.

Klein SM, et al. Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade. Can J Anaesth. 2001;48(4):375-378.

Kumar A. Evaluation of a new posterior subgluteus approach to sciatic nerve. Anesth Analg. 2002;95(3):780.

Latzke D, et al. Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers. Br J Anaesth. 2010;104(2):239-244.

Levesque S, Delbos A. Sciatic nerve block for total-knee replacement: is it really necessary in all patients? Reg Anesth Pain Med. 2005;30(4):410-411.

Mansour NY, Bennetts FE. An observational study of combined continuous lumbar plexus and single-shot sciatic nerve blocks for post-knee surgery analgesia. Reg Anesth. 1996;21(4):287-291.

Merchan MC, et al. The sciatic nerve block: a new posterior approach to sacral plexus. Reg Anesth Pain Med. 2002;27(3):333-334.

Moayeri N, Groen GJ. Differences in quantitative architecture of sciatic nerve may explain differences in potential vulnerability to nerve injury, onset time, and minimum effective anesthetic volume. Anesthesiology. 2009;111(5):1128-1134.

Morin AM, et al. Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005;30(5):434-445.

Morrow MJ. The lateral approach to the sciatic nerve. Anesth Analg. 2000;90(3):770.

Nader A, et al, Sensory testing of distal sural and posterior tibial nerves provides early prediction of surgical anesthesia after single-injection infragluteal-parabiceps sciatic nerve block. Anesth Analg. 2010;110(3):951-957.

Navas AM, de la Tabla Gonzalez RO, Gutierrez TV. Combined femoral-sciatic catheters for postoperative pain treatment after total knee replacement. Anesth Analg. 2007;105(1):288.

Pham Dang C, et al. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005;30(2):128-133.

Ripart J, et al. Parasacral approach to block the sciatic nerve: a 400-case survey. Reg Anesth Pain Med., 2005;30(2):193-197.

Robards C, et al. Sciatic nerve catheter placement: success with using the Raj approach. Anesth Analg. 2009;109(3):972-975.

Rodriguez J, et al. Intraneural catheterization of the sciatic nerve in humans: a pilot study. Reg Anesth Pain Med. 2008;33(4):285-290.

Sala-Blanch X, et al. Structural injury to the human sciatic nerve after intraneural needle insertion. Reg Anesth Pain Med. 2009;34(3):201-205.

Sciard D, Lam N, Hussain M. Continuous sciatic nerve block and total-knee arthroplasty. Reg Anesth Pain Med. 2005;30(4):411-412.

Smith BE, Siggins D. Low volume, high concentration block of the sciatic nerve. Anaesthesia. 1988;43(1):8-11.

Souron V, Eyrolle L, Rosencher N. The Mansour’s sacral plexus block: an effective technique for continuous block. Reg Anesth Pain Med. 2000;25(2):208-209.

Sukhani R, et al. Infragluteal-parabiceps sciatic nerve block: an evaluation of a novel approach using a single-injection technique. Anesth Analg. 2003;96(3):868-873.

Sukhani R, et al. Nerve stimulator-assisted evoked motor response predicts the latency and success of a single-injection sciatic block. Anesth Analg. 2004;99(2):584-588.

Suresh S, et al. Anatomical location of the bifurcation of the sciatic nerve in the posterior thigh in infants and children: a formula derived from MRI imaging for nerve localization. Reg Anesth Pain Med. 2007;32(4):351-353.

Sutherland ID. Continuous sciatic nerve infusion: expanded case report describing a new approach. Reg Anesth Pain Med. 1998;23(5):496-501.

Taboada M, et al. The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine. Anesth Analg. 2004;98(1):242-247.

Taboada M, et al. Plantar flexion seems more reliable than dorsiflexion with Labat’s sciatic nerve block: a prospective, randomized comparison. Anesth Analg. 2005;100(1):250-254.

Taboada M, et al. Does the site of injection distal to the greater trochanter make a difference in lateral sciatic nerve blockade? Anesth Analg. 2005;101(4):1188-1191.

Taboada M, et al. What is the minimum effective volume of local anesthetic required for sciatic nerve blockade? A prospective, randomized comparison between a popliteal and a subgluteal approach. Anesth Analg. 2006;102(2):593-597.

Taboada M, et al. A prospective, randomized comparison between the popliteal and subgluteal approaches for continuous sciatic nerve block with stimulating catheters. Anesth Analg. 2006;103(1):244-247.

Taboada M, et al. Two unusual cases of urinary incontinence during continuous sciatic nerve block with stimulating catheters. Anesth Analg. 2009;108(3):1042-1043.

Taboada Muniz M, et al. Low volume and high concentration of local anesthetic is more efficacious than high volume and low concentration in Labat’s sciatic nerve block: a prospective, randomized comparison. Anesth Analg. 2008;107(6):2085-2088.

Tobe M, et al. Long-term effect of sciatic nerve block with slow-release lidocaine in a rat model of postoperative pain. Anesthesiology. 2010;112(6):1473-1481.

Tran D, Clemente A, Finlayson RJ. A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth. 2007;54(11):922-934.

Tsai TP, et al. Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement. Reg Anesth Pain Med. 2008;33(3):207-210.

Urmey WF, Grossi P. Use of sequential electrical nerve stimuli (SENS) for location of the sciatic nerve and lumbar plexus. Reg Anesth Pain Med. 2006;31(5):463-469.

Vanterpool S, et al. Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations. Reg Anesth Pain Med. 2006;31(5):417-421.

Voelckel WG, et al. Signs of inflammation after sciatic nerve block in pigs. Anesth Analg. 2005;101(6):1844-1846.

Wang CF, et al. An absorbable local anesthetic matrix provides several days of functional sciatic nerve blockade. Anesth Analg. 2009;108(3):1027-1033.

Williams BA, et al. Femoral-sciatic nerve blocks for complex outpatient knee surgery are associated with less postoperative pain before same-day discharge: a review of 1,200 consecutive cases from the period 1996–1999. Anesthesiology. 2003;98(5):1206-1213.

Yung E, et al. Bicarbonate plus epinephrine shortens the onset and prolongs the duration of sciatic block using chloroprocaine followed by bupivacaine in sprague-dawley rats. Reg Anesth Pain Med. 2009;34(3):196-200.

Zaric D, et al. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg. 2006;102(4):1240-1246.

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