Three-dimensional ultrasound-assisted popliteal catheter placement revealing aberrant anatomy: implications for block failure.

Abstract

The current means of introducing continuous sciatic catheters include nerve stimulation, with or without catheter stimulation techniques. More recently, ultrasound has been utilized to facilitate catheter placement. This case represents a stimulating catheter-guided continuous block facilitated by three-dimensional ultrasound, which revealed aberrant anatomy with proximal and wide bifurcation of the sciatic nerve with implications for block failure. Before ultrasound imaging secondary failures were attributed to catheter misplacement or dislodgement. Because of this case observation, our current practice is to use ultrasound confirmation of the bifurcation of the nerve of all popliteal catheter placements, particularly catheters placed in patients having ambulatory procedures to prevent secondary failure of catheters at home.