A Common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block

Sciatic nerve block in the popliteal fossa is associated with a highly variable success rate. Frequently, anesthesia is profound in the distribution of both the tibial (TN) and common peroneal nerves (CPN), although the response to nerve stimulation or paresthesia is obtained in the distribution of one division of the nerve. However, anesthesia in the distribution of only one division of the nerve is also a common occurrence under apparently identical clinical circumstances. Looking for a possible role of a common epineural sheath in these phenomena, we injected dye into the epineural sheath of the tibial nerve in 10 cadaver legs and observed its spread within the sheath. Injections of 15 mL and 30 mL of the dye resulted in a proximal spread of 147 +/- 34 mm and 172 +/- 50 mm, respectively, from the injection point 10 cm below the popliteal fossa crease. In a majority of the legs, the dye reached the division of the sciatic nerve in the popliteal fossa, bathing both the TN and CPN. Gross inspection and histologic examination of the sciatic nerve specimens revealed a common epineural sheath enveloping the TN and CPN. The presence of the common epineural sheath and its characteristics may have important clinical implications for sciatic nerve blockade in the popliteal fossa.