Secondary Logo

Journal Logo


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

di Benedetto, P.1; Bertini, L.; Fanelli, G.2; Casati, A.3

Author Information
European Journal of Anaesthesiology: June 2003 - Volume 20 - Issue 6 - p 497-498

A reply


We all know that the sciatic nerve can be blocked at several levels along the so-called ‘sciatic line’, and a variety of approaches have been described to block the nerve along this line, with little innovation one from another. However, although we thank Drs Singh and Sharma for their interest [1] in our article on a subgluteal approach to the sciatic nerve [2], their suggestion of duplicate publication seems somewhat unwarranted for a research group that has published in the field of regional anaesthesia for over 15 yr. The first point raised concerns about the premedication dose of diazepam that we used. We would also be concerned giving diazepam 30 mg to elderly patients, and this is indeed our own typographical mistake, since they received diazepam 10 mg orally 30 min before block placement, as is routine in our department. We can only apologize for the error and thank Drs Singh and Sharma for pointing it out.

We do not agree that this is a case of duplicate publication but is somewhat related to the unpredictably different editorial history of different papers, coming from different studies produced by the same research group. Let us make just a few observations to clarify this. First of all Drs Singh and Sharma should recognize that it is reasonable that a research group to focus its interest in one restricted area. Accordingly, it is easy to forecast that most of the publications produced by this research group will be focused on very similar topics. The scientific production of this group will vary little from paper to paper, but this does not mean that the authors are duplicating studies. Secondly, we must take into consideration the different editorial history of each manuscript, as well as the speed of the editorial process, which may change widely through different medical journals.

A few years ago we developed this slight modification of the Raj's approach to sciatic nerve block, and then decided to perform an observational study just aimed at describing the ‘new’ technique [2]. When the study was completed we sent the manuscript to a medical journal. In the meantime, we also started with a second-step project comparing this new approach with the classical Labat's approach. Unfortunately, our paper from the first observational study was rejected. Accordingly, we sought to improve this manuscript using the suggestions made by the reviewers and then approached another journal. Interestingly enough, we soon completed a second randomized study, which was fortunately accepted [3].

Furthermore, there are some other factors, which play a crucial role in this hen and egg drama. The length of the review process may range from a couple of months (for journals using online submissions and rapid review systems) to longer; furthermore, the time from when the paper is accepted to publication may vary considerably. The upshot in our case was that our ‘second’ randomized study was published in 2001, while our ‘first’ observational study was published in 2002. We are happy to open our records for inspection to anyone with a legitimate interest in this matter. On the other hand, we consider that using ad verbatim the same description of the technique and method while writing the ‘second’ randomized study to be acceptable; we were always the same anaesthesiologists placing the same type of block for the same type of patients (even though they were different patients!). Our main fault was that we did not correct the proofs of the observational study [2] to include the paper about the second randomized study [3]; this was partly related to the ‘chicken and egg’ problem, and partly to the fact that extensive rewriting of the proofs at a late stage would be necessary – for this we can only apologize to the editorial team and readership of the European Journal of Anaesthesiology. At the same time we also thank Drs Singh and Sharma for their accuracy and constructive criticism [1].

To answer Drs Singh and Sharma's joke, although we all know that the egg came from the chicken, it happens sometime in life that we first see the egg, and then only after notice the chicken: this does not reduce the clinical relevance of either the chicken or the egg.


1. Singh B, Sharma P. Posterior subgluteal approach to block the sciatic nerve: the controversy of ‘which came first, the chicken or the egg’ is alive. Eur J Anaesthesiol 2003;20: 496.
2. 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.
3. Di Benedetto P, Bertini L, Casati A, Borghi B, Albertin A, Fanelli G. A new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach. Anesth Analg 2001; 93: 1040-1044.
© 2003 European Society of Anaesthesiology