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Anterior Ankle Nerve Block

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Anterior Ankle Nerve Block, Regional Anesthesia of the Anterior Ankle, Superficial Peroneal Nerve Block, Deep Peroneal Nerve Block, Saphenous Nerve Block

  • Indications
  1. Anesthesia of the dorsum of the foot
  • Precautions
  1. Avoid injecting directly into nerves
  • Preparation
  1. Needle: 27 gauge 1.5 inch
  2. Anesthetic: Lidocaine 1%: two 10 ml syringes
  • Technique
  1. Patient position
    1. Supine position
    2. Ankle slightly plantar flexed
  2. Injection site 1: Superficial peroneal nerve (most of dorsal foot)
    1. Identify site
      1. Anterior tibial border and
      2. Superior to lateral malleolus
    2. Inject 5 cc Lidocaine 1% subcutaneously
  3. Injection site 2: Deep peroneal nerve (first web space only)
    1. Identify site dorsiflexing ankle against resistance
      1. Between tibialis anterior and extensor hallucis l
      2. Approximately at level between malleoli
    2. Insert needle lateral to anterior tibial artery
      1. Aspirate and inject 5 cc Lidocaine 1%
  4. Injection site 3: Saphenous Nerve (lateral ankle only)
    1. Identify site
      1. Superior and anterior to medial malleolus
    2. Inject 3 cc subcutaneously
  5. Warning: Distal Paresthesias with needle with injection
    1. Indicates needle is in nerve
    2. Do not inject here!
    3. Remove needle and reposition
  • References
  1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  2. Salam (2004) Am Fam Physician 69(4):896 [PubMed]