Leg Regional Anesthesia

Aka: Leg Regional Anesthesia, Ultrasound Guided Regional Anesthesia of the Lower Extremity, Nerve Block of the Foot and Ankle, Foot and Ankle Regional Anesthesia, Ultrasound-Guided Ankle Block

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II. Indications

  1. Regional Anesthesia to allow for procedures (in place of Procedural Sedation)
  2. Severe localized pain control (e.g. Ankle Fracture)
    1. Consider Hematoma Block

III. Contraindications

  1. See Regional Anesthesia

IV. Types: Leg

  1. Images
    1. neuroPeripheralLeg.jpg
  2. Hip
    1. Femoral Nerve Block
    2. Fascia Iliaca Block
    3. PENG Block
    4. Lateral Femoral Cutaneous Nerve Block
  3. Lower leg (below knee)
    1. Popliteal Sciatic Nerve Block (peroneal nerve and tibial nerve)
  4. Ankle
    1. Regional Anesthesia of the Anterior Ankle
      1. Superficial Peroneal Nerve Block
      2. Deep Peroneal Nerve Block
      3. Saphenous Nerve Block
    2. Regional Anesthesia of the Posterior Ankle
      1. Posterior Tibial Nerve Block
        1. Anesthesia of the majority of heel and sole of foot
      2. Sural Nerve Block
        1. Anesthesia of the lateral heel and sole of foot

V. Technique: Complete Lower Leg Anesthesia

  1. Background
    1. Proximal block requires only 2 Nerve Blocks (compared with the ankle, where 5 nerves must be blocked)
    2. Results in foot and ankle motor (paralysis) and sensory Anesthesia
  2. Blocks
    1. Distal Sciatic Nerve Block
      1. Anesthesia of most of the lower leg (except medial ankle and foot)
    2. Saphenous Nerve Block
      1. Anesthesia of the medial ankle and medial foot

VI. Technique: Complete Foot Anesthesia (Ankle Block)

  1. Perform 1-2 Nerve Blocks under Ultrasound guidance
    1. Posterior Tibial Nerve Block
    2. Deep Peroneal Nerve Block (optional)
      1. Deep peroneal nerve only innervates first web space
      2. If Anesthesia is not needed in this region, may avoid Deep Peroneal Nerve Block
  2. Perform Field Block (non-Ultrasound guided) of the anterior ankle
    1. Saphenous Nerve (Medial ankle)
      1. Inject 5 ml SQ in transverse plane, from medial malleolus toward anterior ankle
    2. Sural Nerve (Lateral ankle)
      1. Inject 5 ml SQ in transverse plane, from anterior ankle toward lateral malleolus
  3. References
    1. Ankle Block (Nysora, accessed 12/22/2020)
      1. https://www.nysora.com/regional-anesthesia-for-specific-surgical-procedures/lower-extremity-regional-anesthesia-for-specific-surgical-procedures/foot-and-anckle/ankle-block/

VII. Complications

  1. See Regional Anesthesia
  2. Nerve injury with persistent Paresthesias
  3. See Local Anesthetic System Toxicity (LAST)

VIII. Resources

  1. Local Anesthetics: Clinical Pharmacology and Rational Selection
    1. http://www.nysora.com/regional-anesthesia/foundations-of-ra/3492-local-anesthetics-clinical-pharmacology-and-rational-selection.html
  2. Lower Extremity Nerve Blocks (AAFP, Includes diagrams and videos)
    1. https://www.aafp.org/afp/2020/0601/p669.html References Eicken and Rempell (2016) Crit Dec Emerg Med 30(4):3-11 Reardon and Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020 [https://stabroom.com/
  3. Swaminathan and Stone in Herbert (2019) EM:Rap 19(3): 3-4
  4. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]

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