{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:33:15Z","timestamp":1786649595981,"version":"build-2736575974"},"reference-count":60,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>The sciatic nerve block is a cornerstone of regional anaesthesia for lower limb surgeries, providing effective analgesia and anaesthesia. This narrative review explores the ultrasound-guided sciatic nerve block at proximal levels, emphasising anatomical considerations, sonoanatomy, and various approaches. A detailed understanding of the sciatic nerve\u2019s course and surrounding anatomy at different levels enables practitioners to select the most appropriate technique for optimal outcomes. This article, Part A, focuses on proximal approaches, discussing their advantages, technical nuances, and clinical applications. Dual guidance, which combines ultrasound and peripheral nerve stimulation, is emphasised for improved accuracy, safety, and enhanced success rates. High-resolution ultrasound imaging enhances precision, minimises complications, and ensures precise deposition of local anaesthetic. In the subsequent article (Part B), we will delve into the sciatic nerve block approaches at distal levels, completing a comprehensive guide to ultrasound-guided sciatic nerve blockade. This review aims to serve as a valuable, updated resource for regional anaesthesia enthusiasts and trainees seeking to enhance their knowledge and clinical expertise.<\/jats:p>","DOI":"10.4103\/ija.ija_962_25","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T10:00:21Z","timestamp":1767348021000},"page":"177-199","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Ultrasound-guided sciatic nerve block: An educational review of anatomy and techniques \u2013 Part A: Proximal approaches"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1904-4831","authenticated-orcid":false,"given":"Tuhin","family":"Mistry","sequence":"first","affiliation":[{"name":"Consultant, Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-5505","authenticated-orcid":false,"given":"Kartik","family":"Sonawane","sequence":"additional","affiliation":[{"name":"Consultant, Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2102-2254","authenticated-orcid":false,"given":"Shrabanti","family":"Jana","sequence":"additional","affiliation":[{"name":"Associate Consultant, Department of Anaesthesiology and Critical Care, HOSMAT Hospitals, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2869-8626","authenticated-orcid":false,"given":"Santosh Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Professor, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260102","doi-asserted-by":"crossref","first-page":"110420","DOI":"10.1016\/j.jclinane.2021.110420","article-title":"Combination of real-time needle-tip pressure sensing and minimal intensity stimulation limits unintentional intraneural injection during an ultrasound-guided peripheral nerve block procedure: A randomized, parallel group, controlled trial","volume":"74","author":"Coudray","year":"2021","journal-title":"J Clin Anesth"},{"key":"R2-20260102","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s12871-019-0750-6","article-title":"Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: A randomized clinical trial","volume":"19","author":"Zhang","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"R4-20260102","doi-asserted-by":"crossref","first-page":"e23751","DOI":"10.1016\/j.heliyon.2023.e23751","article-title":"Assessment in location of sciatic nerve between the ischial tuberosity and the greater trochanter of the femur: A cadaveric study","volume":"10","author":"Ma","year":"2023","journal-title":"Heliyon"},{"key":"R5-20260102","doi-asserted-by":"crossref","first-page":"963","DOI":"10.5603\/FM.a2020.0111","article-title":"Morphologic and morphometric characteristics of the adductor minimus in Korean: Its topographic relationship with respect to neighbouring anatomical structure and clinical significance","volume":"80","author":"Kwak","year":"2021","journal-title":"Folia Morphol (Warsz)"},{"key":"R6-20260102","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1136\/rapm-2020-101709","article-title":"Ultrasound-guided subparaneural popliteal sciatic nerve block: There is more to it than meets the eyes","volume":"46","author":"Karmakar","year":"2021","journal-title":"Reg Anesth Pain Med"},{"key":"R7-20260102","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1007\/s00276-021-02824-4","article-title":"The influence of age on the anatomical variability of sciatic nerve divisions in the thigh: An ultrasound study","volume":"43","author":"Segura-Grau","year":"2021","journal-title":"Surg Radiol Anat"},{"key":"R9-20260102","doi-asserted-by":"crossref","first-page":"110352","DOI":"10.1016\/j.jclinane.2021.110352","article-title":"An aberrant vessel crossing the paraneural sheath between the two divisions of the sciatic nerve","volume":"73","author":"Mistry","year":"2021","journal-title":"J Clin Anesth"},{"key":"R10-20260102","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.bja.2019.10.026","article-title":"The posterior femoral cutaneous nerve contributes significantly to sensory innervation of the lower leg: An anatomical investigation","volume":"124","author":"Feigl","year":"2020","journal-title":"Br J Anaesth"},{"key":"R11-20260102","doi-asserted-by":"crossref","first-page":"145","DOI":"10.5505\/agri.2014.26122","article-title":"Ultrasound guided posterior femoral cutaneous nerve block","volume":"26","author":"Top\u00e7u","year":"2014","journal-title":"Agri"},{"key":"R12-20260102","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1002\/jor.23186","article-title":"Surgical anatomy of the sciatic nerve: A meta-analysis","volume":"34","author":"Tomaszewski","year":"2016","journal-title":"J Orthop Res"},{"key":"R13-20260102","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ar.1090700102","article-title":"The relation of the sciatic nerve and of its subdivisions to the piriformis muscle","volume":"70","author":"Beaton","year":"1937","journal-title":"Anat Rec"},{"key":"R14-20260102","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s00276-005-0056-x","article-title":"Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty","volume":"28","author":"Pokorn\u00fd","year":"2006","journal-title":"Surg Radiol Anat"},{"key":"R15-20260102","first-page":"1838","article-title":"Agenesis of the piriformis muscle: A case report with review of literature","volume":"24","author":"Nepal","year":"2020","journal-title":"SA J Radiol"},{"key":"R16-20260102","first-page":"e35302","article-title":"A three-headed piriformis muscle with splitting of the common fibular nerve","volume":"15","author":"Akamefula","year":"2023","journal-title":"Cureus"},{"key":"R17-20260102","first-page":"41","article-title":"Bilateral divided piriformis muscle together with the high division of the sciatic nerve","volume":"13","author":"Demiryurek","year":"2002","journal-title":"Gazi Med J"},{"key":"R18-20260102","first-page":"721","article-title":"Sciatic nerve division: A cadaver study in the Indian population and review of the literature","volume":"51","author":"Prakash,","year":"2010","journal-title":"Singapore Med J"},{"key":"R19-20260102","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00276-009-0546-3","article-title":"Anatomical variations of lumbosacral plexus","volume":"32","author":"Matejc\u00edk","year":"2010","journal-title":"Surg Radiol Anat"},{"key":"R20-20260102","first-page":"e1809","article-title":"Absence of the Lumbosacral Trunk","volume":"9","author":"Schmidt","year":"2017","journal-title":"Cureus"},{"key":"R21-20260102","doi-asserted-by":"crossref","first-page":"35","DOI":"10.18231\/j.ijcap.2025.008","article-title":"A rare case of bilateral higher division of sciatic and common peroneal nerves","volume":"12","author":"Sharma","year":"2025","journal-title":"Indian J Clin Anat Physiol"},{"key":"R22-20260102","doi-asserted-by":"crossref","first-page":"369","DOI":"10.5115\/acb.20.096","article-title":"Reunification of a split sciatic nerve","volume":"53","author":"Huang","year":"2020","journal-title":"Anat Cell Biol"},{"key":"R23-20260102","doi-asserted-by":"crossref","DOI":"10.1002\/ca.24262","article-title":"Optimizing peripheral nerve block placement in hip surgery: A cadaveric study mapping the posterior cutaneous innervation","author":"Gurney","year":"2025","journal-title":"Clin Anat"},{"key":"R24-20260102","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.bjae.2020.04.004","article-title":"The sciatic nerve block","volume":"20","author":"Shevlin","year":"2020","journal-title":"BJA Educ"},{"key":"R25-20260102","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1136\/rapm-2023-104884","article-title":"Standardizing nomenclature in regional anesthesia: An ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks","volume":"49","author":"El-Boghdadly","year":"2024","journal-title":"Reg Anesth Pain Med"},{"key":"R26-20260102","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1002\/jum.14429","article-title":"Ultrasound-guided posterior femoral cutaneous nerve block: A cadaveric study","volume":"37","author":"Johnson","year":"2018","journal-title":"J Ultrasound Med"},{"key":"R27-20260102","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1213\/ane.0b013e31818fc252","article-title":"Ultrasound-guided anterior approach to sciatic nerve block: A comparison with the posterior approach","volume":"108","author":"Ota","year":"2009","journal-title":"Anesth Analg"},{"key":"R28-20260102","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/TheIAForum.TheIAForum_118_23","article-title":"Anterior approach for sciatic nerve localization: A novel observational pilot study utilizing sonoanatomical landmarks","volume":"25","author":"Singh","year":"2024","journal-title":"Indian Anaesth Forum"},{"key":"R29-20260102","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2174\/2589645802115010049","article-title":"Using the BBraun BSmartTM pressure manometer to prevent unsafe injection pressures during simulated peripheral nerve blockade: A pilot study","volume":"15","author":"Smith","year":"2021","journal-title":"Open Anesthesiol J"},{"key":"R30-20260102","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1111\/anae.14330","article-title":"The ability of a real-time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers","volume":"73","author":"Saporito","year":"2018","journal-title":"Anaesthesia"},{"key":"R31-20260102","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1213\/ane.0b013e3181a04d8e","article-title":"Ultrasound localization of the sacral plexus using a parasacral approach","volume":"108","author":"Ben-Ari","year":"2009","journal-title":"Anesth Analg"},{"key":"R32-20260102","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/bja\/aer216","article-title":"Preliminary results of a new ultrasound-guided approach to block the sacral plexus: The parasacral parallel shift","volume":"107","author":"Bendtsen","year":"2011","journal-title":"Br J Anaesth"},{"key":"R33-20260102","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s12630-011-9630-3","article-title":"A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area","volume":"59","author":"Taha","year":"2012","journal-title":"Can J Anaesth"},{"key":"R34-20260102","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/pan.12194","article-title":"Ultrasound-guided parasacral approach to the sciatic nerve block in children","volume":"23","author":"Dillow","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"R35-20260102","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jclinane.2019.03.024","article-title":"The Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia in transfemoral knee amputation","volume":"57","author":"Tulgar","year":"2019","journal-title":"J Clin Anesth"},{"key":"R36-20260102","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jclinane.2019.06.030","article-title":"Parasacral ischial plane (PIP) block: An easy approach to sacral plexus","volume":"59","author":"Venkataraju","year":"2020","journal-title":"J Clin Anesth"},{"key":"R37-20260102","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.62347\/PADU2071","article-title":"Use of ultrasound-guided anterior lumbar plexus block combined with rapid sacral plexus block and laryngeal mask general anesthesia in elderly patients undergoing total hip arthroplasty","volume":"17","author":"Fang","year":"2025","journal-title":"Am J Transl Res"},{"key":"R38-20260102","doi-asserted-by":"crossref","first-page":"712","DOI":"10.4103\/ija.ija_36_24","article-title":"Efficacy of ultrasound-guided classical versus parasacral parallel shift technique of sacral plexus block for lower limb surgeries-A randomised controlled trial","volume":"68","author":"Nair","year":"2024","journal-title":"Indian J Anaesth"},{"key":"R39-20260102","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1136\/rapm-00115550-199318050-00013","article-title":"Reevaluating the sciatic nerve block: Another landmark for consideration","volume":"18","author":"Mansour","year":"1993","journal-title":"Reg Anesth"},{"key":"R40-20260102","first-page":"111","article-title":"Ultrasound guided single injection lumbosacral plexus blockade for hip surgery anaesthesia","author":"Bendtsen","year":"2013","journal-title":"Br J Anaesth"},{"key":"R41-20260102","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jclinane.2019.08.038","article-title":"Parasacral ischial plane (PIP) block: Cadaveric validation","volume":"60","author":"Narayanan","year":"2020","journal-title":"J Clin Anesth"},{"key":"R42-20260102","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1186\/s13018-024-04822-9","article-title":"A proof-of-concept study of ultrasound-guided continuous parasacral ischial plane block for postoperative pain control in patients undergoing total knee arthroplasty","volume":"19","author":"Ye","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"R43-20260102","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/00000542-200602000-00017","article-title":"Ultrasound examination and localization of the sciatic nerve: A volunteer study","volume":"104","author":"Chan","year":"2006","journal-title":"Anesthesiology"},{"key":"R44-20260102","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1097\/00000539-200110000-00049","article-title":"A new posterior approach to the sciatic nerve block: A prospective, randomized comparison with the classic posterior approach","volume":"93","author":"di Benedetto","year":"2001","journal-title":"Anesth Analg"},{"key":"R45-20260102","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1093\/bja\/ael364","article-title":"Ultrasound-guided sciatic nerve block: Description of a new approach at the subgluteal space","volume":"98","author":"Karmakar","year":"2007","journal-title":"Br J Anaesth"},{"key":"R46-20260102","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/AAP.0b013e318232eb92","article-title":"Three-dimensional\/four-dimensional volumetric ultrasound imaging of the sciatic nerve","volume":"37","author":"Karmakar","year":"2012","journal-title":"Reg Anesth Pain Med"},{"key":"R47-20260102","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1213\/ANE.0000000000000462","article-title":"A prospective, randomized comparison between single- and multiple-injection techniques for ultrasound-guided subgluteal sciatic nerve block","volume":"119","author":"Yamamoto","year":"2014","journal-title":"Anesth Analg"},{"key":"R48-20260102","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/AAP.0b013e31824bde5c","article-title":"Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block","volume":"37","author":"Hara","year":"2012","journal-title":"Reg Anesth Pain Med"},{"key":"R49-20260102","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/AAP.0000000000000016","article-title":"Ultrasound-guided sciatic nerve block in overweight and obese patients: A randomized comparison of performance time between the infragluteal and subgluteal space techniques","volume":"38","author":"Abdallah","year":"2013","journal-title":"Reg Anesth Pain Med"},{"key":"R50-20260102","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1111\/anae.14368","article-title":"A lateral approach to ultrasound-guided sacral plexus block in the supine position","volume":"73","author":"Wang","year":"2018","journal-title":"Anaesthesia"},{"key":"R51-20260102","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s00276-010-0709-2","article-title":"A new lateral approach to the parasacral sciatic nerve block: An anatomical study","volume":"33","author":"Le","year":"2011","journal-title":"Surg Radiol Anat"},{"key":"R52-20260102","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12871-025-02943-0","article-title":"A modified approach of combined anterior lumbar plexus block with lateral sacral plexus block in a semi lateral supine position for lower limb fracture patients: A case series","volume":"25","author":"Ji","year":"2025","journal-title":"BMC Anesthesiol"},{"key":"R53-20260102","doi-asserted-by":"crossref","first-page":"111108","DOI":"10.1016\/j.jclinane.2023.111108","article-title":"Lateral parasacral ischial plane block: A novel approach to the sacral plexus in the supine position","volume":"87","author":"Zheng","year":"2023","journal-title":"J Clin Anesth"},{"key":"R54-20260102","first-page":"712","article-title":"An ultrasound-guided lateral approach for proximal sciatic nerve block: A randomized comparison with the anterior approach and a cadaveric evaluation","volume":"43","author":"Yoshida","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R55-20260102","doi-asserted-by":"crossref","DOI":"10.1136\/rapm-2018-100203","article-title":"Proximal lateral approach to ultrasound-guided sciatic nerve block: A volunteer and cadaveric study","author":"Nielsen","year":"2019","journal-title":"Reg Anesth Pain Med"},{"key":"R56-20260102","doi-asserted-by":"crossref","first-page":"110726","DOI":"10.1016\/j.jclinane.2022.110726","article-title":"A novel anterior approach for ultrasound-guided sacral plexus block","volume":"79","author":"Li","year":"2022","journal-title":"J Clin Anesth"},{"key":"R57-20260102","doi-asserted-by":"crossref","first-page":"111864","DOI":"10.1016\/j.jclinane.2025.111864","article-title":"Postoperative analgesic effects of combined transversus abdominis plane block and anterior approach of sacral plexus block in patients undergoing laparoscopic radical prostatectomy: A randomized controlled trial","volume":"104","author":"Shao","year":"2025","journal-title":"J Clin Anesth"},{"key":"R58-20260102","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1097\/00000542-199912000-00017","article-title":"A new anterior approach to the sciatic nerve block","volume":"91","author":"Chelly","year":"1999","journal-title":"Anesthesiology"},{"key":"R59-20260102","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1399-6576.2006.01177.x","article-title":"Ultrasound examination of the sciatic nerve at the anterior thigh in obese patients","volume":"51","author":"Chantzi","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"R60-20260102","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1136\/rapm-00115550-200805000-00017","article-title":"Ultrasound-guided anterior sciatic nerve block using a longitudinal approach: \u201cExpanding the view\u201d","volume":"33","author":"Tsui","year":"2008","journal-title":"Reg Anesth Pain Med"},{"key":"R61-20260102","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1093\/bja\/aes492","article-title":"Ultrasound-guided anterior sciatic nerve block in the proximal thigh: An in-plane approach improving the needle view and respecting fascial planes","volume":"110","author":"Dolan","year":"2013","journal-title":"Br J Anaesth"},{"key":"R62-20260102","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1093\/bja\/aev351","article-title":"Comparative evaluation of the visibility and block characteristics of a stimulating needle and catheter vs an echogenic needle and catheter for sciatic nerve block with a low-frequency ultrasound probe","volume":"115","author":"Brookes","year":"2015","journal-title":"Br J Anaesth"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_962_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:55:48Z","timestamp":1786647348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_962_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":60,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_962_25","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}