We have demonstrated the successful use of real-time US guidance in combination with LOR to saline for paramedian epidural access with the epidural needle inserted in the plane of the US beam.

Lumbar plexus block (LPB) is frequently used in combination with an ipsilateral sacral plexus or sciatic nerve block for lower limb surgery. This is traditionally performed using surface anatomical landmarks, and the site for local anaesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. In this report, we describe a technique of ultrasound-guided LPB that was successfully used, in conjunction with a sciatic nerve block, for anaesthesia during emergency lower limb surgery. The anatomy, sonographic features, technique of identifying the lumbar plexus, and the potential benefits of using this approach are discussed.

Sciatic nerve block is frequently used for anaesthesia or analgesia during orthopaedic foot surgery and there are several different approaches to the sciatic nerve. This report describes a new approach to the sciatic nerve using ultrasound. Local anesthetic was injected into the 'subgluteal space' under ultrasound guidance which was effective in producing sciatic nerve block in a small series of five patients. The anatomy, sonographic features, technique of identifying the subgluteal space, and potential advantages of this approach to the sciatic nerve are discussed.