The proximal sciatic nerve block is an advanced regional anaesthesia technique used for lower limb surgeries, including knee replacement, tibial osteotomy, and amputations. The sciatic nerve, the largest peripheral nerve, originates from the lumbosacral plexus (L4–S3) and courses through the greater sciatic foramen before descending into the posterior thigh. Various approaches, including parasacral, dorsal, anterior, lateral, transgluteal, subgluteal, and ultrasound-guided techniques, provide effective blockade based on surgical requirements. The block is commonly performed with a femoral nerve block to ensure complete lower limb anaesthesia. Ultrasound guidance enhances precision and safety, minimising complications such as vascular puncture, intraneural injection, and motor impairment. However, risks include temporary motor blockade, falls, and rare pelvic organ perforation. The sciatic block can be performed at multiple levels, and each technique has specific anatomical landmarks and procedural steps, with ultrasound-guided approaches improving accuracy and reducing reliance on nerve stimulation. The choice of technique depends on patient positioning, surgical site, and anaesthetic expertise. Proximal sciatic nerve blocks provide excellent analgesia, making them a valuable component of multimodal pain management in lower limb surgeries.