Comparing Classical Approach and Crosswise Approach to Popliteal Sciatic Nerve Block

NCT07134608 | Completed

• 1 other identifier: JEPUKM-JEP-2023-973
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Sensory and motor innervation below the knee is provided mainly by the popliteal-sciatic nerve except for a variable area of the medial leg supplied by the saphenous nerve. Regional anaesthesia and analgesia for below knee surgery are frequently provided by blocking the popliteal sciatic nerve in the popliteal fossa. Popliteal sciatic block was first introduced around the 1970s and has emerged as a popular technique for below knee surgery despite other types of lower limb peripheral nerve block. This is contributed because popliteal fossa offers a superficial and accessible location for nerve blockade. This anatomical feature simplifies the procedure and may reduce the risk of complications such as vascular puncture or nerve injury. Analgesia provided by the popliteal sciatic block lasts significantly longer than with ankle blocks. One of the reasons is administration of local anaesthetic agent at the popliteal fossa allows it to bathe the sciatic nerve before it bifurcates into the tibial and common peroneal nerves, leading to a more extensive and prolonged nerve blockade. Besides the sciatic nerve at the popliteal level is encased in a common epineural sheath, which can facilitate the spread of the anaesthetic and prolong its effect. The popliteal sciatic block can be performed as a single-shot technique or as a continuous infusion via a catheter The success rate of popliteal sciatic block is dependent on several variables, including the operator's skill, patient considerations, and surgical variables. This study comparing between 2 approaches of popliteal sciatic nerve ie: classical approach and relatively new approach that is crosswise approach of popliteal sciatic nerve (CAPS) block.

Conditions

Popliteal Sciatic Nerve Block

Outcome Measures

Primary Outcomes (1)

• Pain score during positioning and block performance

  Using verbal numerical rating scale (VNRS),ranging from 0 to 10, where 0 = no pain and 10 = the worst pain imaginable.

  Time from positioning and block performance until completion of block (preoperative).

Secondary Outcomes (5)

• Fentanyl consumption

  On operative day until post operative day 1

• Onset of block

  Immediately after block completion until 30 minutes after.

• Failure rate

  30 minutes after block completion

• Patient's satisfaction

  One day after procedure.

• Complications

  On operative day until post operative day 1

Study Arms (2)

Classical Popliteal Sciatic Nerve Block

ACTIVE COMPARATOR

Patients turned to the right or left lateral decubitus position, depending on which lower limb was planned for operation (i.e., right lateral decubitus if the operation was on the left lower limb and vice-versa). A pillow was placed between the lower limbs to facilitate block access and patient comfort. The classical popliteal sciatic block was done using a ultrasound machine with a high-frequency linear or low-frequency curvilinear probe placed 5-6 cm cranial to the popliteal fossa crease while identifying the bifurcation of the sciatic nerve. Skin infiltration with 5 ml of lignocaine 2% was performed using a 23G,followed by in-plane introduction of an 80 mm 22G block needle, aiming to penetrate the sciatic nerve sheath at the level of bifurcation, with placement confirmed using a nerve stimulator. After confirming negative aspiration for blood, 20 ml of Ropivacaine 0.5% was injected, and the spread of LA within the sheath was confirmed by ultrasound.

Procedure: Popliteal Plexus Block with 20 ml

Crosswise Approach to Popliteal Sciatic Nerve (CAPS block)

ACTIVE COMPARATOR

Patients in remained in the supine position. The CAPS block was performed using a similar Sonosite SII® ultrasound machine with a high-frequency linear or low-frequency curvilinear probe placed lateral to the thigh, 5-6 cm cranial to the popliteal fossa crease, while identifying the bifurcation of the sciatic nerve into the tibial and common peroneal nerves. Thereafter, the block proceeded similarly to patients in Group A, with 5 ml of lignocaine 2% for skin infiltration, in-plane introduction of the block needle aiming to penetrate the sciatic nerve sheath at the level of bifurcation and placement confirmed with a nerve stimulator, followed by injection of 20 ml of Ropivacaine 0.5% after confirming negative aspiration for blood. The spread of LA within the sheath was confirmed by ultrasound.

Procedure: Popliteal Plexus Block with 20 ml

Interventions

Popliteal Plexus Block with 20 ml PROCEDURE

Different position while blocking the popliteal sciatic nerve block

Classical Popliteal Sciatic Nerve Block; Crosswise Approach to Popliteal Sciatic Nerve (CAPS block)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• planned for either elective or non-elective unilateral below-knee surgery at HUKM
• patients aged 18 years and older and classified as physical status I, II, or III as dictated by the American Society of Anaesthesiologists (ASA)

You may not qualify if:

• included pregnant patients, those with a body mass index (BMI) ≥40 kg/m², contraindicated to peripheral nerve block (such as existing nerve injury to the limb intended for surgery), patient refusal, severe coagulopathy, local anaesthetic (LA) allergy, active infection at the intended block site, patients unable to provide a pain score using a verbal numerical rating scale (VNRS)

Sponsors & Collaborators

• National University of Malaysia: lead

Study Sites (1)

Hospital Canselor Tuanku Muhriz

Kuala Lumpur, Kuala Lumpur, 56000, Malaysia

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 21, 2025
• First Posted: August 21, 2025
• Study Start: November 1, 2023
• Primary Completion: November 30, 2024
• Study Completion: November 30, 2024
• Last Updated: August 21, 2025

Record last verified: 2025-05

Locations

MY (1)