Intra-articular Ankle Block

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Chapter 7 Intra-articular Ankle Block

Overview

When performing an intra-articular ankle block, an anterolateral approach is preferred.

Indications for use

The intra-articular ankle block is used for ankle fracture reduction.

Precautions

1. Use of the lateral malleolus as a landmark helps prevent damage to the dorsal cutaneous nerve.
2. In patients with significant swelling, tendinous structures are difficult to palpate.

Pearls

1. A topical anesthetic with ethyl chloride may be used to reduce patient discomfort.
2. Positioning the ankle in slight plantarflexion provides easier access to the joint.

Equipment

1. Antiseptic: Chlorhexidine prep stick
2. Syringe: 10-mL syringe
3. Anesthetic:

a. Lidocaine: 5 mL of 2%
b. Bupivacaine: 5 mL of 0.5%

4. Needle: 1½-inch, 22-gauge needle
5. Sterile gloves
6. 4 × 4 inch gauze

Basic technique

1. The patient should be supine with the ankle in slight plantarflexion.
2. Landmarks:

a. Lateral malleolus
b. Peroneus tertius tendon

(1) The site of entry is 2.5 cm proximal and 1.3 cm anterior to the tip of the lateral malleolus.
(2) This site of entry is immediately lateral to the peroneus tertius tendon.

3. Steps:

a. Position the patient.
b. Palpate landmarks.
c. Prepare the skin with an antiseptic solution.
d. Place sterile drapes around the ankle.
e. Administer a topical anesthetic, if desired.
f. Inject anesthetic into the joint.
g. Place a sterile bandage over the injection site.

Detailed technique

1. Position the patient so he or she is supine with the ankle in slight plantarflexion.
2. Palpate landmarks:

a. Feel the most distal aspect of the lateral malleolus.
b. The site of entry is slightly more than the breadth of one finger proximal and half the breadth of a finger anterior.
c. Mark this site.

3. Prepare the skin with an antiseptic solution. Perform a wide preparation.
4. Place sterile drapes around the ankle. Drape out proximally, distally, and laterally.
5. Administer a topical anesthetic, if desired.
6. Inject anesthetic into the joint (Figure 7-1):

a. Enter at a 60-degree angle to the skin.
b. Insert the needle in a posterior and medial direction.
c. Advance 0.5 to 1 cm to enter the joint.
d. Inject the anesthetic.
7. Place a sterile bandage over the injection site.
image

Figure 7-1

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Chapter 7 Intra-articular Ankle Block

Overview

When performing an intra-articular ankle block, an anterolateral approach is preferred.

Indications for use

The intra-articular ankle block is used for ankle fracture reduction.

Precautions

1. Use of the lateral malleolus as a landmark helps prevent damage to the dorsal cutaneous nerve.
2. In patients with significant swelling, tendinous structures are difficult to palpate.

Pearls

1. A topical anesthetic with ethyl chloride may be used to reduce patient discomfort.
2. Positioning the ankle in slight plantarflexion provides easier access to the joint.

Equipment

1. Antiseptic: Chlorhexidine prep stick
2. Syringe: 10-mL syringe
3. Anesthetic:

a. Lidocaine: 5 mL of 2%
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