US-guided Popliteal Sciatic Nerve Block

Description of how to perform a single-injection popliteal sciatic nerve block. This is ideal for foot and ankle surgery in combination with an adductor canal or saphenous nerve block.
00:06 - Clinical indications
00:32 - Preparation for block
01:33 - Positioning for block
02:31 - Scanning phase
04:08 - Pendulum maneuver for ID of nerves
04:39 - Identify injection point at bifurcation
05:47 - Needle trajectory and approach
08:08 - Needling and injection phase
08:46 - Assess and recognize appropriate spread
11:49 - In-plane block video
14:27 - Out-of-plane block video

[@KiJinnChin]

Additional videos of actual popliteal blocks are at kzbin.info/www/bejne/Z4CpkKSfoq9nqdE and kzbin.info/www/bejne/m4qzkqiqisd3a9k

[@rhonda29687]

Fascinating! I just had this exact block done yesterday. Very effective as I’m 18 hours post-op and still no need to pain meds.

[@wafaibrahim369]

Thanks you for all

[@supreetsingh7797]

The best video I’ve found showing the in plane value of plane (!) views. Thanks Dr. Chin.

[@bridge4christ]

Best video I've seen on the popliteal block with clear rationale and explanations!

[@YoNorton]

Fantastic video. Your descriptions, pearls, and techniques are exceptional.

[@firelight3912]

It is owner of anesthesia to have excellent teacher like YOU ....Allah bless you

[@mattnjaa]

Excellent video. Nice clinical pearls throughout.

[@123shainz]

one of the best vedio i ever have seen

[@ananthashan]

Superb presentation!

[@kiklocus4660]

awesome video thank you

[@veeranlee7407]

sir please upload videos of sciatic,femoral,obturator nerve blocks usg guided..ur teachings are excellent

[@ananthashan]

Superb!

[@timjen764]

High quality! Thank you

[@wafaibrahim369]

Thanks

[@docanamika510]

Thanks 🙏🏻🙏🏻

[@chandrikakamath2707]

Thank you for the detailed and excellent video. Can i ask a question please? Is it possible for a patient to have persistent sensory loss in all toes after a popliteal sciatic nerve block ? Usg + pns was used. Regained full motor action. He'd undergone peripheral angioplasty in the same limb a day earlier. Elderly gentleman with PVD. The surgery done was debridement over the foot dorsum. We dont have the device to check injection pressure, however there was no paraesthesia at any time and we also went down to 0.4 mA when we got a motor response. Thanking in anticipation

[@kicapification]

Regarding the use of surgical thigh tourniquet, would the addition of femoral and obturator nerve block be adequate? (Please help me understand why would tourniquet pain require spinal or GA)

[@KiJinnChin]

The size of the thigh plus the pressure of 250-300mmHg usually leads to significant pain; much more than in the upper arm. To anesthetize the thigh, you need a femoral nerve block (obturator is optional IMO) and a proximal sciatic nerve block. This is possible, but would come at the expense of complete motor block of the entire lower limb. Which is not usually desirable for foot/ankle surgery.

[@wafaibrahim369]

Thanks ❤️💜💜🌿

[@mj-uy8sd]

thank you very much

[@mahmoudmadian2464]

Thank you sir for this excellent illustration video. My question is about the wireless US probe, is it possible to achieve these blocks with such probe or it should be a high quality device?

[@muhammadjalil1131]

Thanks sir

[@DocSCL1960]

Can you do the popliteal nerve block without locating the popliteal artery as the landmark? I was having difficulty finding the popliteal artery with the patient in the lateral position. My colleague just locate the area where the "nerve split" into two branches. These was no vascular pulsation on ECHO. He just injected. Is this a correct approach?

[@heathscheibmeir8011]

Thanks so much for this, extremely informative! Question: for OOP, how far distal from the probe do you place the needle, and at what angle do you approach the nerve(s)? Did one of them today that I got to work well, but I think I had the needle too close to the probe at the start which limited my ability to move the needle somewhat. Looks like you’re about an inch or so distal from the probe as you insert the needle, with an angle about 45 degrees to the probe to target nerves and US beam?

[@KiJinnChin]

You start by determining the angle that you want to use to approach the nerve, and that determines how far away from the probe you insert the needle through the skin. For comfort and ergonomics, you probably don't want to exceed 60 deg in steepness otherwise the needle hub and your fingers will get uncomfortably close to the probe as you insert deeper. Most people find 30-45 deg comfortable. In which case, start at a distance = depth of the target, with an additional 0.5 cm or so. You can adjust the angle as you go.

[@heathscheibmeir8011]

Much appreciated, thanks!

[@AH-hz5xc]

Superficial is anterior to the artery bud not posterior

[@KiJinnChin]

If you are approaching from the posterior aspect of the knee, as we usually are, then superficial is with reference to the skin surface, and is posterior with reference to the artery.

[@AH-hz5xc]

@@KiJinnChin Thank you for explaining.

[@isaacra]

Great description! is the pendulum maneuver your technique?

[@KiJinnChin]

00:06 - Clinical indications 00:32 - Preparation for block 01:33 - Positioning for block 02:31 - Scanning phase 04:08 - Pendulum maneuver for ID of nerves 04:39 - Identify injection point at bifurcation 05:47 - Needle trajectory and approach 08:08 - Needling and injection phase 08:46 - Assess and recognize appropriate spread 11:49 - In-plane block video 14:27 - Out-of-plane block video

[@chandrikakamath2707]

Thank you for your videos. They are all well detailed and clear. One question with this block - where exactly should the needle be introduced with the patient in lateral position and in what direction should the needle be advanced in the in plane approach?

[@KiJinnChin]

@@chandrikakamath2707 it's easiest to advance from lateral to medial if going in-plane. If going out of plane then I usually advance distal to proximal.

[@RoamingDoctors]

Volume of video is very low😳