The significance of tibial and common peroneal nerves in nerve blocks
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ORIGINAL ARTICLE
The significance of tibial and common peroneal nerves in nerve blocks Je-Hun Lee • Be-Na Lee • Michael Y. Lee Xiaochun An • Seung-Ho Han
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Received: 25 April 2012 / Accepted: 15 September 2012 / Published online: 27 September 2012 Ó Springer-Verlag France 2012
Abstract Purpose The aim of this study was to elucidate the anatomical location of tibial nerve (TN) and common peroneal nerve (CPN) in the popliteal crease for specific nerve block. Methods Fifty fresh specimens from 27 adult Korean cadavers (16 males and 11 females, age 35–87 years) were investigated. Five of the 27 cadavers were used to determine the depths of nerves in cross-section. Results Tibial nerve was located 50 % from the most lateral point of the popliteal crease and 1.4-cm deep to the surface. In 20 % of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26 % from the most lateral point of the popliteal crease and 0.7-cm deep from the surface. Furthermore, in 6 % of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease.
J.-H. Lee Department of Anatomy, College of Medicine, The Konyang University of Korea, Daejeon, Korea B.-N. Lee Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea M. Y. Lee Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina, Chapel Hill, NC, USA X. An S.-H. Han (&) Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea e-mail: [email protected]
Conclusion The results concerning the location of the TN and CPN at the popliteal crease offer a good guide to optimal nerve block. Keywords
Anatomy Popliteal crease Nerve block
Introduction A popliteal nerve block (PopNB) is often used during surgery and to treat spasticity below the knee [11, 16]. It is important for clinicians and researchers to understand the location of nerves when considering nerve block [3]. The classical and intertendinous approaches are used for PopNB. The classical approach is frequently used and involves inserting the needle 7 cm above the popliteal crease and 1 cm lateral to the midline of the popliteal fossa triangle [4]. The intertendinous approach involves injection at the midpoint between the tendons of the biceps femoris and the semitendinosus. Some studies have concluded that the intertendinous approach is the more useful of the two [4, 12]. These two approaches, which involve injections at the sciatic nerve (SN), are referred to collectively as prebifurcation blocks. However, blocking the tibial nerve (TN) and common peroneal nerve (CPN) separately may provide a faster onset than a prebifurcation block [2, 13]. Sometimes surgeons must make a blind injection in clinical practice. Such an injection does not take into account anatomical variations of the sciatic nerve. Thus, incomplete block of the sciatic nerve in the popliteal
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