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

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)

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