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A common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block
Original
5. 6.
7.
8.
Contributions
sion to the hospital following ambulatory surgery. JAMA 1989; 262:3008-10. Osborne GA, Rudkin GE: Outcome after day-care surgery in a major teaching hospital. Am&h Intensive Care 1993;21:822-7. Watcha MF, White PF: Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiolop)l 1992;77:16284. Georgiev M, Ricci S, Carbone D, Antignani P, Moliterno C: Stab avulsion of the shot saphenous vein. Technique and duplex examination. JDermatol Surg Oncol1993;19:456-64. Ricci S, Georgiev M: Office varicose vein surgery under local anesthesia. JDermatol Surg Oncol1992;18:55-8.
9. Brown
DL: Popliteal
Anesthesia. Philadelphia: 10. Aldrete
JA, Kroulik
block. In: Brown W.B. Saunders D: A postanesthetic
DL, eds. Atlas of Co., 1992:109-13. recovery score.
of Anesthesiology, NY
11. Brown TC, Dickens DR: A new approach to posterior cutaneous nerve of thigh block. Anaesth Intensive Care 1986;14:126-7. 12. Vloka JD, HadiiC A, Lesser JB, et al: A Common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block. An&h Analg 1997;84:387-90. 13. Beardsley D, Holman S, Gantt R, et al: Transient neurologic deficit after spinal anesthesia: local anesthetic maldistribution with pencil point needles? An&h Analg 1995;81:314-20.
St. Luke’s-Roosevelt
Hospital
Center,
Abstract Sciatic nerve block in the popliteal fossa is associated with a highly variable success rate. Frequently, anesthesia is profound in the distribution of both the tibia1 (TN) and common peroneal nerves (CPN), although the response to nerve stimulation or paresthesia is obtained in the distribution of one division of the nerve. However, anesthesia in the distribution of only one division of the nerve is also a common recurrence under apparently identical clinical circumstances. Looking for a possible role of a common epineural sheath in these phenomena, we injected dye into the epineural sheath of the tibia1 nerve in 10 cadaver legs and observed its spread within the sheath. Injections of 15 mL and 30 mL of the dye resulted in a proximal spread of 147 2 34 mm and 172 t 50 mm, respectively, from the injection point 10 cm below the popliteal fossa crease. In a majority of the legs, the dye reached the division of the sciatic nerve in the popliteal fossa, bathing both the TN and CPN. Gross inspection and histologic examination of the sciatic nerve specimens revealed a common epineural sheath enveloping the TN and CPN. The presence of the common epineural sheath and its characteristics may have important clinical implications for sciatic nerve blockade in the popliteal fossa. Reprinted
622
J. Clin. Anesth.,
from Anesthesia and Analgesia
vol. 9, December
1997
An&h
An&g 1970;63:206-7.
A Common Epineural Sheath for the Nerves in the Popliteal Fossa and Its Possible Implications for Sciatic Nerve Block JD. Vloka, A. Hadzic, J.B. Lesser,E. Kitain, H. Geatz, E. W. Afril, 0.111. Thys Department New York,
Regional
1997;84:387-90.
5. 6.
7.
8.
Contributions
sion to the hospital following ambulatory surgery. JAMA 1989; 262:3008-10. Osborne GA, Rudkin GE: Outcome after day-care surgery in a major teaching hospital. Am&h Intensive Care 1993;21:822-7. Watcha MF, White PF: Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiolop)l 1992;77:16284. Georgiev M, Ricci S, Carbone D, Antignani P, Moliterno C: Stab avulsion of the shot saphenous vein. Technique and duplex examination. JDermatol Surg Oncol1993;19:456-64. Ricci S, Georgiev M: Office varicose vein surgery under local anesthesia. JDermatol Surg Oncol1992;18:55-8.
9. Brown
DL: Popliteal
Anesthesia. Philadelphia: 10. Aldrete
JA, Kroulik
block. In: Brown W.B. Saunders D: A postanesthetic
DL, eds. Atlas of Co., 1992:109-13. recovery score.
of Anesthesiology, NY
11. Brown TC, Dickens DR: A new approach to posterior cutaneous nerve of thigh block. Anaesth Intensive Care 1986;14:126-7. 12. Vloka JD, HadiiC A, Lesser JB, et al: A Common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block. An&h Analg 1997;84:387-90. 13. Beardsley D, Holman S, Gantt R, et al: Transient neurologic deficit after spinal anesthesia: local anesthetic maldistribution with pencil point needles? An&h Analg 1995;81:314-20.
St. Luke’s-Roosevelt
Hospital
Center,
Abstract Sciatic nerve block in the popliteal fossa is associated with a highly variable success rate. Frequently, anesthesia is profound in the distribution of both the tibia1 (TN) and common peroneal nerves (CPN), although the response to nerve stimulation or paresthesia is obtained in the distribution of one division of the nerve. However, anesthesia in the distribution of only one division of the nerve is also a common recurrence under apparently identical clinical circumstances. Looking for a possible role of a common epineural sheath in these phenomena, we injected dye into the epineural sheath of the tibia1 nerve in 10 cadaver legs and observed its spread within the sheath. Injections of 15 mL and 30 mL of the dye resulted in a proximal spread of 147 2 34 mm and 172 t 50 mm, respectively, from the injection point 10 cm below the popliteal fossa crease. In a majority of the legs, the dye reached the division of the sciatic nerve in the popliteal fossa, bathing both the TN and CPN. Gross inspection and histologic examination of the sciatic nerve specimens revealed a common epineural sheath enveloping the TN and CPN. The presence of the common epineural sheath and its characteristics may have important clinical implications for sciatic nerve blockade in the popliteal fossa. Reprinted
622
J. Clin. Anesth.,
from Anesthesia and Analgesia
vol. 9, December
1997
An&h
An&g 1970;63:206-7.
A Common Epineural Sheath for the Nerves in the Popliteal Fossa and Its Possible Implications for Sciatic Nerve Block JD. Vloka, A. Hadzic, J.B. Lesser,E. Kitain, H. Geatz, E. W. Afril, 0.111. Thys Department New York,
Regional
1997;84:387-90.