Barrington Michael J, Lai Su-Ling K, Briggs Chris A, Ivanusic Jason J, Gledhill Samuel R
Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia.
Reg Anesth Pain Med. 2008 Jul-Aug;33(4):369-76. doi: 10.1016/j.rapm.2007.12.004.
Ultrasound-guided sciatic nerve block is a relatively new regional anesthesia technique with few descriptions in the literature. The objective of this study was to assess the ease with which the sciatic nerve could be imaged in the midthigh region using ultrasound and to describe the anatomy surrounding the sciatic nerve at this location.
In this prospective observational study, 40 patients scheduled for surgery where sciatic nerve block was indicated were scanned between the gluteal and the popliteal regions using an ultrasound machine (Vivid-i, GE Healthcare, Chalfont St. Giles, Bucks, UK). Patients then received real time ultrasound-guided sciatic nerve block. Validation of the ultrasound image of the sciatic nerve was achieved using nerve stimulation. Description and confirmation of the anatomy surrounding the sciatic nerve was based on a review of anatomical texts and an anatomical study on 5 unembalmed cadavers.
The sciatic nerve was identified with ultrasound and its image validated using nerve stimulation in 38 of 40 patients (95%). In 15 patients (37.5%) nerve stimulation was required to confirm identification of the sciatic nerve. Surrounding muscles (biceps femoris, vastus lateralis, and adductor magnus) and fascial planes (lateral intermuscular septum) were identified as sonographic landmarks and were confirmed in the anatomical study.
Ultrasonic identification of the sciatic nerve at the midthigh level can be achieved; however, in this study, 37.5% of patients required nerve stimulation to confirm its sonographic appearance. Target nerve localization and the subsequent performance of the sciatic nerve block may be enhanced by recognition of surrounding muscular and fascial structures which were also identified using ultrasound.
超声引导下坐骨神经阻滞是一种相对较新的区域麻醉技术，文献中对此描述较少。本研究的目的是评估使用超声在大腿中部区域对坐骨神经进行成像的难易程度，并描述该部位坐骨神经周围的解剖结构。
在这项前瞻性观察研究中，对40例计划进行手术且需要进行坐骨神经阻滞的患者，使用超声仪（Vivid-i，通用电气医疗集团，英国白金汉郡查尔方特圣贾尔斯）在臀区和腘窝区之间进行扫描。然后患者接受实时超声引导下的坐骨神经阻滞。通过神经刺激对坐骨神经的超声图像进行验证。基于对解剖学文献的回顾以及对5具未防腐尸体的解剖学研究，对坐骨神经周围的解剖结构进行描述和确认。
40例患者中有38例（95%）通过超声识别出坐骨神经，并经神经刺激验证了其图像。15例患者（37.5%）需要神经刺激来确认坐骨神经的识别。周围肌肉（股二头肌、股外侧肌和大收肌）和筋膜平面（外侧肌间隔）被确定为超声标志，并在解剖学研究中得到证实。
在大腿中部水平可通过超声识别坐骨神经；然而，在本研究中，37.5%的患者需要神经刺激来确认其超声图像。识别周围的肌肉和筋膜结构（这些结构也可通过超声识别）可能会提高目标神经定位以及后续坐骨神经阻滞的操作效果。
