Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach

Rania Maher Hussien*, Dalia Ahmed Ibrahim, Islam Gamal Hamed Abdelnaby
Department of Anaesthesia and ICU, Ain Shams University, Cairo, Egypt

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Creative Commons License
© 2018 Hussien et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Anaesthesia and ICU, Ain Shams University, 4 Eladeeb Mohamed Elsbaee, Elnozha, Cairo, Egypt, Tel: 01000544520; E-mail:



Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches.


To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate.

Settings and Design:

After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation.


Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28) femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking to rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA.


Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, and required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach.


Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate

Keywords: Below knee amputation, Femoral nerve block, Popliteal nerve block, Sciatic nerve block, Sub-gluteal, Ultrasound guided.