A frontal approach aiming at penetrating the subgluteal space where the sciatic nerve runs has been described by Raj et al. [53] and used in children for many years. This technique has recently gained a renewed interest in adults [54,55]. The patient is placed supine and the legs are flexed over the pelvic girdle (usually by an aid); this positioning is very easily achieved in infants, whilst it is more difficult to sustain in grown up children and adolescents (Figure 6). The site of puncture is the midpoint of the line joining the greater trochanter and the ischial tuberosity. The block needle is introduced perpendicularly to the skin, in direction to the lateral border of the ischial tuberosity, i.e., medially and cranially until muscle twitches are elicited in the foot. If the needle contacts the ischial tuberosity without any twitches, it should be withdrawn and reinserted slightly more laterally.





     Figure 6. Proximal frontal approach to the sciatic nerve
     1. Ischial tuberosity
     2. Greater trochanter of the femur