Sim Case

Patients were positioned in Sim’s position. Line was drawn from the posterior superior iliac spine to the midpoint of the greater trochanter. A perpendicular line was drawn bisecting this line, which extended 5 cm caudally. A second line was drawn from the greater trochanter to the sacral hiatus. The intersection of this line with the perpendicular line indicated the point of needle entry figure1[9].
Then sterilization of the site of needle insertion, a 12 cm, 20 gauge short-beveled stimulating needle attached to a nerve stimulator and attached to the surface electrode was inserted with a 90-degree angle to the skin and advanced until either plantar flexion or dorsiflexion of the foot was obtained. Initially, the stimulating current was set between 1.5 to 2 mA, and the frequency of stimulation was set at 2 Hz. The intensity of the stimulating current was gradually decreased as the needle approached the targeted nerve. The position of the needle was adjusted to maintain an adequate muscular response with a stimulating current < 0.5 mA. The goal is visible or palpable twitches of the hamstrings, calf muscles, foot, or toes at 0.2-0.5 mA current. After reaching the goal, the solution injected in the studed groups.
The extent of sensory block of each nerve was classified as follows: 0 = normal sensation in the respective nerve distribution (no block), 1= blunted sensation (analgesia) and 2 = absence of sensation (anesthesia). Motor block onset was assessed by asking the patient to plantar flex or dorsiflexion the foot. It was classified as follows: 0 = normal movement, 1 = decreased movement and 2 = no movement. When the sensory block or motor block score was > 2 at the end of the 40-min assessment period, the sciatic block was considered incomplete and excluded from our study. Also the duration of sensory nerve block and motor block were