Popliteal Nerve Block Periprocedural Care

Updated: Aug 29, 2016
  • Author: Alma N Juels, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Periprocedural Care

Equipment

Needed equipment includes the following:

  • An ultrasound machine with a probe of 10-12 MHz frequency.
  • An 80-mm 22 gauge needle, depth 3-4 cm.
  • Local anesthetic to inject and for the skin wheal.
  • Sterile prep, ChloraPrep preferred.
  • Ultrasound gel, not necessarily sterile since needle inserted away from probe.
  • Tegaderm to place on tip of probe.
  • Echogenic non stimulating needles.
  • An insulated stimulating needle (which can be connected to a nerve stimulator if wanted; these needles tend not to be very echogenic).
  • Nerve stimulator (if wanted in adjunct to ultrasound images or if an ultrasound is not available): A 21-gauge or 22-gauge insulated needle, nerve stimulator set at 1-1.5 mA, pulse frequency of 1 Hz, and pulse duration of 0.1 msec. Attach needle to nerve stimulator and place grounder on patient.
  • Local anesthetic (see Anesthesia in Patient Preparation): If a good image exists, 20cc is all that’s necessary with the use of an ultrasound. Increasing the volume may increase the duration of the block but also increases the chance of complications. Maximum of 40cc, also need to consider weight-based toxicity of local anesthetic used.
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Patient Preparation

Anesthesia

For surgical anesthesia in adults, a single shot of 30 cc of 1.5% Mepivacaine plain provides close to immediate (5 min) to 2-3 hrs of surgical analgesia. For longer surgical anesthesia up to 3-4 hrs, 1:400,000 epinephrine is added to the solution. The block completely resolves about 2 hrs later. If a longer block is needed, adding Tetracaine at 2mg/cc (0.2%) prolongs the block to 4-6 hrs. Also consider 15ccl of 1.5% Mepivicaine with 15 cc of 0.5% Bupivicaine injected, this will give you immediate surgical anesthesia and longer-acting analgesia, over 12 hrs

For longer postoperative analgesia, 0.25% Ropivacaine or Bupivacaine is used and should provide more than 12 hr of pain relief. The onset is delayed from 5 min to about 20 min. This can be used for both perioperative and postoperative pain control. Once again, 20-40cc depending on patient's weight and anatomy.

Positioning

For the popliteal block, the patient can be in 3 different positions: supine, lateral, and prone. The preferred position depends on patient comfort and the clinician’s experience.

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