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    Ankle Block: Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software Statistics

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    Raj
    Ankle block for ankle surgery.. Helps both anesthesiologists and surgeons.. Avoids general anesthsia

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    Ankle Block: Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software Statistics

    Uploaded by

    Raj
    53 views27 pages
    Ankle block for ankle surgery.. Helps both anesthesiologists and surgeons.. Avoids general anesthsia

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    Ankle Block

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    Ankle block for ankle surgery.. Helps both anesthesiologists and surgeons.. Avoids general anesthsia

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    53 views27 pages

    Ankle Block: Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software Statistics

    Uploaded by

    Raj
    Ankle block for ankle surgery.. Helps both anesthesiologists and surgeons.. Avoids general anesthsia

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    Ankle block

    Dr. S. Parthasarathy
    • MD., DA., DNB, MD (Acu), Dip. Diab. DCA,
    Dip. Software statistics
    • PhD (physio)
    • Mahatma Gandhi Medical college and
    research institute , puducherry India
    Indication
    • Anaesthesia and postoperative analgesia of
    the foot.
    • Patient Selection
    • The ankle block is principally an infiltration
    block and does not require elicitation of
    paraesthesia. Thus, patient cooperation is not
    mandatory.
    Anatomic Landmarks
    • Five nerves supply the foot,
    • four of which derive from the sciatic nerve
    (the tibial, the superficial and deep peroneal,
    the sural nerves) and
    • one from the femoral nerve (the saphenous
    nerve).
    Anatomy of ankle nerves
    Posterior tibial nerve
    Cross section
    Area of innervations
    Technique
    • Generally, infiltration techniques are used for
    ankle blocks
    • The posterior tibial nerve can be blocked by a
    nerve stimulator technique.
    • All blocks are performed at the upper levels
    of the malleoli.
    • patients should be adequately sedated during
    this block because it is primarily a “volume”
    block.
    Patient Position
    • The patient lies supine in neutral position or
    slight internal and then external rotation
    according to the nerve to be blocked

    Pillow to raise
    SAPHENOUS NERVE BLOCK

    • The saphenous nerve runs in the superficial fascia in


    front of the medial malleolus accompanying the
    saphenous vein and innervates the medial side of the
    foot.
    • Technique
    • For saphenous nerve block, 3 to 5 mL of local
    anesthetic is injected subcutaneously on either side
    of the saphenous vein at the superior aspect of the
    medial malleolus
    Saphenous N block
    TIBIAL NERVE BLOCK

    • The tibial nerve lies under the flexor


    retinaculum at the midpoint between the
    medial malleolus and calcaneus
    • A point is marked midway between the medial
    malleolus and calcaneus. If the posterior tibial
    artery is palpated, the needle is inserted just
    posterior to the pulse, following which 3–5 mL
    of local anesthetic is injected.
    TIBIAL NERVE BLOCK
    • Conversely, a 25-mm stimulating needle can
    be inserted at the skin mark and directed
    posterior to the tibial arterial pulse, looking
    • for plantarflexion of the toes.
    Tibial and sural nerves
    The sural nerve
    • located superficially between the lateral
    malleolus and the Achilles tendon. A 25-
    gauge, 3-cm needle is inserted lateral to the
    tendon and directed toward the malleolus as
    5 to 10 mL of solution is injected
    subcutaneously
    Peroneal nerves
    DEEP PERONEAL NERVE BLOCK
    • A needle is inserted perpendicular to skin just
    lateral to the extensor hallucis longus tendon
    to contact the tibia. It is then withdrawn a few
    millimeters and 3 mL of local anesthetic is
    injected.
    SUPERFICIAL PERONEAL NERVE BLOCK
    • Subcutaneous infiltration of 5 to 7 mL of local
    anaesthetic from the lateral to the medial
    malleolus.
    Drugs
    • motor blockade is not often needed, pt. can
    walk with analgesia
    • 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.
    • Epinephrine ???, especially if injection is
    circumferential.
    Anatomy and USG
    Local injected
    Deep peroneal nerve
    Sural nerve
    Complications
    • Induration may cause difficulty
    • Partial anaesthesia
    • Pain with mutiple injections
    • Infection
    • Haematoma
    • Nerve injury
    Summary - ankle block
    Anaesthesia analgesia of foot
    Five nerves , 4 sciatic and one femoral
    Tibial, deep and sup. Peroneal, sural
    Saphenous
    Tibial and deep peroneal deeper (USG)
    Others superficial (normal technique)
    Technique
    Complications
    We should know all blocks because we
    may need to anaesthetize such people
    Thank you all

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