Popliteal Block

Question 1

What structures define the popliteal fossa?

Answer 1

The popliteal crease, the medial border of the biceps femoris
muscle laterally, and the semitendinosus muscle medially.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1122.

Question 2

How is a popliteal block performed?

Answer 2

A horizontal line is drawn that connects the medial border of the
biceps femoris and the lateral border at the tendon of the
semitendinosis muscle at the level of the popliteal crease.
From the middle of the line just drawn, a line is extended
towards the head about 15 cm. A local anesthetic skin wheal is
created 1 cm lateral to the end of this line. The needle is
advanced through the skin wheal at a 45 to 60 degree
superiorly. The sciatic nerve is usually located at a depth of
about 1-2 cm. 35-40 mL of local anesthetic is injected after a
negative blood aspiration.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1122.

Question 3

What nerve is being blocked with a popliteal block?

Answer 3

The sciatic nerve
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1122.

Question 4

For what surgeries is a popliteal block sufficient?

Answer 4

With augmentation by a saphenous nerve block, foot and ankle
surgeries and below-the-knee amputation can be performed via
a popliteal block.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1016.

Question 5

Which areas of the lower leg would still have
sensation after the successful performance of a
popliteal block on a patient?

Answer 5

A popliteal block spares the medial anterior calf and dorsum of
the foot. A supplementary femoral nerve block is required to
block its terminal saphenous branch which innervates the
medial anterior calf and the dorsum of the foot.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1013-1014.

Question 6

Where in the popliteal fossa can the popliteal artery

be found?

Answer 6

The popliteal artery may be found immediately lateral to the
semitendinosus tendon.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1013-1014.

Question 7

Where does the sciatic nerve give off the tibial and

common peroneal branches?

Answer 7

The sciatic nerve divides into the tibial and common peroneal
nerve, but does so at the upper boundary of the popliteal fossa,
not inferior to it.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1013.

Question 8

What nerves of the foot will a popliteal block

anesthetize?

Answer 8

A nerve block in the popliteal fossa will anesthetize both the
common peroneal and tibial branches of the sciatic nerve which
terminate as the superficial peroneal, deep peroneal, sural, and
posterior tibial nerves.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1013-1014.

Question 9

All of the nerves of the foot and ankle are branches

of the sciatic nerve except for:

Answer 9

The saphenous nerve, which is a branch of the femoral nerve
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1016

Question 10

What are the contraindications for a popliteal block?

Answer 10

Patient refusal, allergy to local anesthetics, infection or
hematoma at the site of injection, and progresive neuropathy.
With regard to anticoagulation, the same contraindications and
precautions that apply for neuraxial anesthesia apply to
popliteal block.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1492.