Sciatic Nerve Catheter Placement: Success with Using the Raj Approach

BACKGROUND: Continuous regional analgesia has increased in popularity and is becoming standard of care for many painful surgical procedures. Various approaches of sciatic catheter insertion have been proposed, each with attributes and disadvantages. We investigated whether the Raj approach that uses a simple midpoint landmark between the ischial tuberosity and greater trochanter will facilitate sciatic catheter placement. METHODS: After informed consent, 20 patients were recruited to receive sciatic catheter placement using the Raj approach. An insulated Tuohy needle was inserted perpendicular to skin at the midpoint of a line between the ischial tuberosity and greater trochanter. After sciatic nerve stimulation, a catheter was inserted 2-4 cm past the end of the needle and secured. The catheters were then incrementally injected with 30 mL of 1.5% mepivacaine. Twenty minutes after local anesthetic injection, sensory block was assessed using cold and pinprick tests, whereas motor block was assessed using a modified Bromage score. Complications and side effects were recorded. RESULTS: In all instances, blocks were easy to perform and were successful. No major side effects or complications were noted. CONCLUSION: Use of a simple landmark between easily identifiable bony structures enhances the simplicity and placement of a sciatic nerve catheter and is recommended for use in clinical practice. (Anesth Analg 2009;109:972-5)