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Tibial Nerve. This Nerve Is Located Posterior To The: Procedure Landmarks

This document describes how to perform an ankle block to provide anesthesia to the nerves in the ankle region. It involves injecting local anesthetic around 5 nerves - the tibial nerve, deep peroneal nerve, superficial peroneal nerve, saphenous nerve, and sural nerve. For each nerve, it specifies the landmarks to locate the nerve and how much local anesthetic to inject. A 22-gauge needle is used and epinephrine should be avoided in the local anesthetic. Care must be taken to avoid intraneural injection which can damage the small nerves.

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Misa Ajverson
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118 views1 page

Tibial Nerve. This Nerve Is Located Posterior To The: Procedure Landmarks

This document describes how to perform an ankle block to provide anesthesia to the nerves in the ankle region. It involves injecting local anesthetic around 5 nerves - the tibial nerve, deep peroneal nerve, superficial peroneal nerve, saphenous nerve, and sural nerve. For each nerve, it specifies the landmarks to locate the nerve and how much local anesthetic to inject. A 22-gauge needle is used and epinephrine should be avoided in the local anesthetic. Care must be taken to avoid intraneural injection which can damage the small nerves.

Uploaded by

Misa Ajverson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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22 ANKLE BLOCK

12
procedure
Landmarks

Tibial Nerve. This nerve is located posterior to the Figure 22-5


posterior tibial artery at the level of the medial
malleolus. Palpate the artery and insert the needle
passing posterior to the artery. A nerve stimulator
can be used to help localize the nerve. The needle
will typically contact the medial malleolus; after
this contact occurs, slightly withdraw the needle.
Inject 3 to 5 mL of local anesthetic (Figure 22-2).
Figure 22-3

Deep Peroneal Nerve. This nerve runs lateral to


the dorsalis pedis artery at the level of the foot. Figure 22-5
Palpate the artery and insert the needle lateral Saphenous Nerve. Inject a subcutaneous wheal of
to the artery. If bone is contacted, withdraw the local anesthetic (5 mL), directing it posteriorly from
needle slightly before injecting 2 to 4 mL of local the tibial ridge to the medial malleolus (Figure
anesthetic (Figure 22-3). 22-5).

Sural Nerve. Insert the needle between the Achilles


Superficial Peroneal Nerve. Inject a subcutaneous
tendon and the lateral malleolus, and subcutane-
wheal of local anesthetic (5 mL) from the anterior
ously infiltrate 5 mL of local anesthetic along this
border of the tibia to the lateral malleolus (Figure
course (Figure 22-6).
22-4).
Needle. 22-gauge, 5-cm, b-bevel needle.

Figure 22-2

Figure 22-4

Figure 22-6

Teaching Points. Do not use epinephrine-con-


taining local anesthetic for this block. If a pares-
thesia is elicited, the needle should be redirected
prior to injection because intraneural injection
can cause significant damage in these small
nerves. Injection around the ankle can be un-
comfortable; preemptive analgesia can be very
helpful.
80

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