Nerve Block at the Ankle

Published on 07/02/2015 by admin

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Last modified 07/02/2015

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Nerve Block at the Ankle

Douglas A. Dubbink, MD

Anesthesia distal to the ankle is accomplished by interrupting the five major nerves that innervate the foot: the tibial nerve and the deep peroneal nerve, which supply the deep structures of the foot, and the superficial peroneal nerve, the sural nerve, and the saphenous nerve, which supply sensory innervation to the skin. The ankle block is a relatively easy block to learn if the anatomy is well understood. Ankle blocks can be effective for nearly any surgical procedure of the foot. Major complications are rare; however, prolonged paresthesias have been reported. No epinephrine-containing local anesthetic agents should be used when performing an ankle block.

Technique

The tibial nerve supplies the sole and plantar portions of the toes up to the nails. It lies behind the posterior tibial artery anteromedial to the Achilles tendon and deep to the flexor retinaculum, which must be penetrated for a successful block (Figure 130-1).

Figure 130-1 A, Anatomic landmarks for block of the posterior tibial and sural nerves at the ankle. B, Posterior tibial nerve: method of needle placement for block at the ankle. C, Sural nerve: method of needle placement for block at the ankle. (From Miller RD, ed. Nerve block at the ankle. In: Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010:1659-1661.)

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