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Posterior subgluteal approach to block the sciatic nerve: the controversy of ‘which came first, the chicken or the egg’ is alive

Singh, B.1; Sharma, P.2

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European Journal of Anaesthesiology: June 2003 - Volume 20 - Issue 6 - p 496
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We read the article by Di Benedetto and colleagues [1] describing the new approach to block the sciatic nerve with tremendous interest mixed with a sense of déjà vu. The technique claimed to be safe, easy to perform and causing minimal discomfort to the patient; needs to be lauded and authors complimented for the innovation.

However, we have some points to make. First, the dose of oral diazepam for premedication; ‘30 mg, 30 min before placing the block’. Thirty milligrams is a large dose considering the long half-life of diazepam and particularly because some of the patients in their study may have been in the late middle age or even beyond 60 yr (as suggested by the mean age of 44 ± 18 yr). Also, the 30 min time interval between the oral administration and placing the block is too short.

Secondly, the authors have very modestly proposed that ‘further studies are required to compare this new approach to other proximal approaches to the sciatic nerve, particularly the classical posterior approach of Labat modified by Winnie’. But haven't the authors already done that and even published it nearly a year ago [2]? In fact, large chunks of text have been lifted ad verbatim from that article while the remaining matter has been culled to give it a different look. The only difference besides the number of patients in the subgluteus group in the earlier study [2] is the dose of oral diazepam, 10 mg, which is more acceptable than 30 mg. Why a three-fold increase in the dose of diazepam was needed is difficult to understand (unless it is a printing error). What has disappointed us the most is the fact that the authors have just concealed their earlier study [2], and we believe that even the publishers of the European Journal of Anaesthesiology would not be aware of it. It also needs to be clarified if the patients in subgluteus group in the earlier study were included in the present study. We leave it to the publishers to decide whether it is a case of duplicate publication?

In describing and proposing further studies after conducting and reporting comparative study with the commonly performed technique and even the continuous subgluteus nerve block [3], the authors surely have given a new look to the controversy: which came first, the chicken or the egg?

B. Singh

P. Sharma

B. Singh Department of Anaesthesia and Critical Care Lady Hardinge Medical College and Associated Hospitals New Delhi, India

P. Sharma Vardbman Mahavir Medical College and Safdarjung Hospital New Delhi, India


1. Di Benedetto P, Casati A, Bertini L, Fanelli G. Posterior subgluteal approach to block the sciatic nerve: description of the technique and initial clinical experiences. Eur J Anaesthesiol 2002; 19: 682-686.
2. Di Benedetto P, Bertini L, Casati A, Borghi B, Albertini A, Fanelli G. A new approach to the sciatic nerve: a prospective, randomized comparison with the classical posterior approach. Anesth Analg 2001; 93: 1040-1044.
3. Di Benedetto P, Casati A, Bertini L. Continuous subgluteus sciatic nerve block after orthopedic foot and ankle surgery: comparison of two infusion techniques. Reg Anesth Pain Med 2002; 27: 168-172.
© 2003 European Society of Anaesthesiology