The exam begins with the ultrasound transducer in the transverse orientation at the popliteal crease. The patient may be prone but PNBschool recommends the patient remain supine with the operative leg raised and rested on a table or leg holding device.

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The popliteal artery is identified in the popliteal fossa. Remember, nerves below the belt line are hyperechoic on ultrasound. The tibial nerve is identified superficial and lateral to the artery    (image 2). The peroneal nerve is just lateral and superficial to the tibial nerve. Once the tibial nerve is identified on ultrasound the probe is moved proximal while following the tibial nerve as it combines with the peroneal nerve to form the sciatic nerve (Image 3). The exam depth will need to be adjusted as the probe is moved proximally. Once the sciatic nerve is identified the needle is inserted from the lateral aspect of the leg using the in plane approach. Approximately 10 to 20ml of local anesthetic is injected adjacent to the sciatic nerve with visualization of your block needle at all times. The needle may be moved while visualized to ensure adequate spread of local anesthetic around the sciatic nerve. 

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The popliteal sciatic nerve block may be used for procedures involving the knee, lower leg and foot excluding a variable strip of skin on the medial leg and foot whichis innervated by the saphenous nerve.

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