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The popliteal fossa contains numerous structures including the common peroneal and tibial nerves, popliteal artery and vein, posterior femoral cutaneous nerve, the genicular branch of the obturator nerve, the small saphenous vein, lymph nodes, bursae and fat (Figure 4).
Palpation of the popliteus muscle must occur through the overlying structures of the popliteal fossa.
Popliteus is located deep, close to the floor of the popliteal fossa
The popliteal fossa is bordered inferiorly by the two heads of the gastrocnemius muscle and superiorly by the semimembranosus and semitendinosus muscles and biceps femoris muscles.
The common peroneal and tibial nerves branch off the sciatic nerve in the popliteal fossa.
Table 4 Peripheral Blocks at the Popliteal Fossa, Ankle, and Digits, Summary Technique Neural Target/Indications Comments Popliteal Target: Sciatic nerve Injection Volume: 30 ml, Block (prior to its division (ultrasound); otherwise, into the common peroneal 10-30 mL.
We designed a study to test the hypothesis that ultrasound visualisation of the distal sciatic nerve in the popliteal fossa with subsequent ultrasound-guided injection of local anaesthetic will result in a reduced amount of injected local anaesthetic, shorter performance times, equivalent block quality (sensory and motor onset time and duration) and less patient discomfort compared with the nerve stimulation-guided distal sciatic nerve block.
After obtaining approval of the Institutional Review Board of the Radboud University and written informed consent, 40 patients ASA Physical Status I to III undergoing surgery of the foot or ankle under regional anaesthesia with a distal sciatic nerve block in the popliteal fossa were randomly assigned to one of two equal groups.
Braun, Melsungen, Germany) insulated block needle attached to a nerve stimulator (HNS 11, Braun Melsungen, Germany) was inserted perpendicular to the skin at the midpoint between the tendons of the biceps femoris and semintendinosus muscle, 8 to 10 cm above the popliteal fossa crease.