Ankle Block

17 Ankle Block



Perspective


This block is often used for surgical procedures carried out on the foot, especially for those not requiring high lower-leg tourniquet pressure.




Patient Selection


The ankle block is principally an infiltration block and does not require elicitation of paresthesia. Thus, patient cooperation is not mandatory. Although the block is most efficient for the anesthesiologist if the patient can assume the prone as well as the supine position, this is not essential.



Pharmacologic Choice


Because motor blockade is not often needed for procedures carried out during ankle block, lower concentrations of local anesthetics may be used. Practical choices are 1% lidocaine, 1% mepivacaine, 0.25% to 0.5% bupivacaine, and 0.2% to 0.5% ropivacaine. Many physicians suggest that epinephrine should not be used during ankle block, especially if injection is circumferential.



Placement




Anatomy


The peripheral nerves requiring block during ankle block are derived from the sciatic nerve, with the exception of a terminal branch of the femoral nerve, the saphenous nerve. The saphenous nerve is the only branch of the femoral nerve below the knee; it courses superficially anterior to the medial malleolus, providing cutaneous innervation to an area of the medial ankle and foot. The remaining nerves requiring block at the ankle are terminal branches of the sciatic nerve—the common peroneal and tibial nerves. The tibial nerve divides into the posterior tibial and sural nerves, which provide cutaneous innervation as outlined in Figure 17-1. The common peroneal nerve divides into its terminal branches, the superficial and deep peroneal nerves, in the proximal portion of the lower leg. Their cutaneous innervation is also illustrated in Figure 17-1

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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Ankle Block

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