Ankle and Foot Nerve Blocks

imagesUsed to provide regional anesthesia to the foot in order to facilitate the following:


   imagesPrimary closure/exploration of foot wounds


   imagesIncision and drainage


   imagesRemoval of foreign bodies


   imagesOperative intervention


imagesPreferred technique because glabrous skin of the epidermis and fibrous septae in the dermis of the foot limit local diffusion of anesthetic


CONTRAINDICATIONS



imagesPatient refusal


imagesInfection overlying injection sites


imagesRelative contraindications: Coagulopathy, systemic infection


LANDMARKS



imagesThere are five nerves which supply the entire surface of the foot (FIGURE 81.1); anatomic landmarks to locate individual nerves are found in the text


TECHNIQUE



imagesPreparation


   imagesObtain informed consent


   imagesPosition patient supine with knee in flexion and foot placed flat on the gurney


   imagesSterilize the area of injection with povidone–iodine or chlorhexidine solution


   imagesDrape the area with sterile towels


   imagesPrepare one to three 10-mL syringes filled with anesthetic of choice


   imagesUse 25-gauge to 30-gauge needle



imagesGeneral Basic Steps


   imagesIdentify landmarks


   imagesPrepare for sterile procedure


   imagesInject anesthetic


POSTERIOR TIBIAL NERVE BLOCK



imagesInnervation: Divides into medial and lateral plantar nerves to supply most of the plantar aspect of the foot


imagesLocation: Medial aspect of the ankle between medial malleolus and Achilles tendon


imagesTechnique (FIGURE 81.2)


   imagesPalpate posterior tibial artery posterior to medial malleolus


   imagesDirect needle at 45-degree angle to mediolateral plane, posterior to artery


   imagesAt depth of artery (0.5–1 cm deep), move needle slightly to induce paresthesia


   imagesIf elicited, 3 to 5 mL of anesthetic is injected after aspiration


   imagesWithdraw 1 mm, then infiltrate 5 to 7 mL of anesthetic while withdrawing 1 cm



images


FIGURE 81.1 The sensory nerve supply to the foot. (From Brown DL, ed. Atlas of Regional Anesthesia. 4th ed. Philadelphia, PA: Elsevier Saunders; 2010:135–138.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Ankle and Foot Nerve Blocks
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