Continuous Popliteal Nerve Block: Intertendinous Approach

Overview

• Indications: Ankle and foot surgery
• Landmarks:
  • Popliteal fossa crease
  • Tendons of the semitendinosus
• Semimembranosus muscles
• Nerve stimulation: Twitch of the foot or toes at 0.2-0.5mA current
• Local anesthetic: 35-45 mL
• Complexity level: Advance

Continuous popliteal block is an advanced regional anesthesia technique and solid experience with the single-shot technique is recommended to ensure its efficacy. The technique is similar to the single-shot injection, however, slight angulation of the needle cephalad is necessary to facilitate threading the catheter. Securing and maintenance of the catheter are easy and convenient. This technique can be used for surgery and postoperative pain management in patients undergoing a wide variety of lower leg, foot, and ankle surgeries.

The patient is placed in the prone position with the feet protruding off the table to facilitate monitoring of the foot or toe responses to nerve stimulation.

A standard regional anesthesia tray is prepared with the following equipment:

• Sterile towels and 4"x4" gauze packs
• Three 20mL syringes with local anesthetic
• Sterile gloves, marking pen, and surface electrode
• One 1
  
  

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