The ultrasound-guided distal sciatic nerve block is the ideal block for patients with distal leg and ankle injuries (large lateral leg laceration, pain reduction from bimalleolar fractures, Achilles tendon rupture, lower leg burns, abscesses, etc.). Depending on the anesthetic used, the block can facilitate fracture reduction or abscess drainage or be used as an adjunct in a multimodal plan for pain control. Unfortunately, the superficial structures of the medial lower leg and ankle are not innervated by the distal sciatic nerve, and a saphenous nerve block (distal aspect of the femoral nerve) may be needed if a more complete analgesia to the lower leg is desired.
The block can facilitate fracture reduction or abscess drainage or be used as an adjunct in a multimodal plan for pain control.
The distal sciatic nerve innervates the majority of the lower extremity below the knee, making it an ideal block for ankle and distal tibial/fibular fractures and injuries to the foot (see Figure 1). It does not provide anesthesia to the medial aspect of the lower leg, which is innervated by the saphenous nerve (a distal branch of the femoral nerve).