Popliteal Sciatic Block - In-plane Approach #2 ("Block Bytes")

"Block Bytes" are interesting (and hopefully useful) snippets of information I've gathered while teaching and performing blocks. Here I highlight more tips and tricks for an inplane approach to the popliteal sciatic block, again using trainee videos as real-world examples of what can be accomplished.
See the first Block Bytes video at • Popliteal Sciatic Bloc...
And the comprehensive popliteal sciatic block video at • US-guided Popliteal Sc...

[@drdrhproductions5626]

I like these bytes. Keep them coming!

[@RoamingDoctors]

Very good videos n excellent teaching.. thank you from india

[@streen2000]

Great tips, thanks! I've found your videos to be so helpful, for our own education and for teaching our trainees! For your first clip, the needle trajectory seemed pretty steep to get to the lateral edge of the CPN. If spread then was still suboptimal would you have opted to just do a repuncture and advance perpendicular the the U/S beam, like in your approach #1?

[@KiJinnChin]

Yes, your suggestion to re-insert at a shallowe trajectory is an excellent one. An additional skin puncture is not that big a deal, especially if it helps you perform a safe and successful block. However I will say that steep trajectories are not as concerning in practice as people think - you can usually track the needle tip quite easily by its MOTION, even though the shaft won't be very echogenic. Mastery of gentle controlled advancement and probing motions is very helpful.

[@streen2000]

@@KiJinnChin yes you're absolutely right about that. I think I've generally stuck to shallow/horizontal trajectories when supervising trainees because it's just easier on my heart that way.. But not necessarily the best option! Oh well new year goals I guess haha. Thanks again!

[@huzaifahabdulwahab1499]

i was wondering.. if the surgeons insist on putting a tourniquet on the thighs, can i get away by performing a popliteal sciatic nerve block + fascia iliaca instead of spinal?

[@KiJinnChin]

A thigh tourniquet is generally too painful to tolerate for any prolonged period of time without general anesthesia or spinal anesthesia. I doubt if a fascia iliaca will produce a dense enough block of the quadriceps to block this pain; you are also left with unblocked hamstrings, which will also contribute to pain. I've never tried it...