Only a small number of surgeries can be carried out by means of the sciatic nerve block independently. Nevertheless, when merged with the comparatively simple femoral nerve block, it is possible to block the complete lower end. The two together offer surgical anesthesia as well as complete relief from postoperative pain.
Even for ankle or lateral foot surgical procedure, both types of nerve blocks are generally required, since the majority of the surgeons make use of a thigh tourniquet. The application of a thigh tourniquet can cause a great deal of pain and discomfort to the patient, so it is necessary for the surgeon to use both femoral and sciatic nerve block to anesthetize the thigh completely.
It is possible to use sciatic nerve block without or with the femoral block for controlling postoperative pain, which generally transpires after ankle or foot surgery. However, a number of surgeons have a preference for not doing this, since they believe that such a high intensity of postoperative pain relief might conceal symptoms, which are connected with increasing compartment syndrome following surgery.
There are generally four types of sciatic nerve block approaches, such as, the supine lithotomy approach, the posterior approach, the anterior approach and the lateral approach. Although each of these approaches has its own set of advantages and disadvantages, the anterior sciatic nerve block approach is the one, which is performed by very few doctors, owing to inadequacy of training and familiarity.
As a matter of fact, out of all the approaches, the anterior sciatic nerve block approach is linked with maximum failure rate. This may be due to insufficiency of knowledge about the technique and the anatomy associated with this kind of nerve block.
Furthermore, a number of doctors try the block devoid of the application of the nerve stimulator, which can apparently reduce success rates.
Anterior sciatic nerve block approach
Simultaneously, the anterior sciatic nerve block approach also offers a lot of advantages. It is extremely convenient to execute, since it can be carried out when the patient is in the supine posture. The patient does not have to be placed in lateral position, which is quite painful, for the application of this approach.
However, in spite of these benefits doctors prefer not to use anterior sciatic nerve block approach since it is quite technically challenging to perform this approach.One should also make a note of the fact that, because of the length of the sciatic nerve, the anterior sciatic nerve block approach might need about thirty minutes to completely set up.
Besides, this procedure produces a moderately distal nerve block and for that reason, it is feasible to overlook the thigh’s posterior cutaneous nerve. However, this is actually not a major concern, but perception of it might prove to be crucial.
Apparently, a good amount of understanding of anatomy as well as the eagerness to inject a reasonably long syringe is necessary for anterior sciatic nerve block. Nevertheless, proper knowledge of this procedure will prove to be beneficial in case of certain patients, who need a nerve block devoid of change in posture.