Eight ball, corner pocket: the optimal needle position for ultrasound-guided supraclavicular block.

of surface landmarks for the lateral popliteal sciatic-nerve block depends upon the accurate location of the groove between the lateral border of the vastus lateralis muscle and tendon of the biceps femoris muscle.1-3 This process can be challenging, particularly in the muscular or obese patient, and maneuvers designed to accentuate the groove necessitate mobilization of what might be a traumatized limb. We propose the fibula as a fixed landmark that is easily palpable in all patients, regardless of body habitus, and that, more significantly, does not require limb mobilization for identification. With the patient in a supine position, the ipsilateral lower limb is placed in the anatomic position with the foot at a 90° angle to the horizontal plane of the table. The head of the fibula is identified, and a line parallel to the long axis of the fibula and horizontal to the plane of the table is traced proximally at this level. A second line is traced laterally from the upper edge of the patella. The needle insertion site is defined as the intersection of these two lines (Fig 1). The stimulating needle is advanced in the same direction and the block performed in the same manner as previously described.1,2 This minor modification to the classically described approach of lateral popliteal sciatic-nerve block is a simple technique that relies on clear, easy identifiable landmarks. The need to mobilize the potentially traumatized limb is eliminated, making block performance easier for patient and physician alike.