Ankle Block

Question 1

What nerves are blocked when performing an ankle

block?

Answer 1

Deep peroneal, Saphenous, Posterior tibial, Sural, Superficial
peroneal
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1016

Question 2

When performing an ankle block, how is the deep
peroneal nerve anesthetized? What other nerves
can be anesthetized at the same time?

Answer 2

By injecting 5-8ml of local anesthetic in the groove located
proximally by the extensor hallucis longus tendon and extensor
digitorum longus tendon. By redirecting the needle toward the
lateral malleolus and injecting another 5-8 mL, the superficial
peroneal nerve can be blocked. Redirecting again toward the
medial malleolus and injecting another 5-8 mL, the saphenous
nerve can be anesthetized.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1017.

Question 3

How would you anesthetize the tibial nerve as part of

an ankle block?

Answer 3

Injecting 5-8 mL of local anesthetic in a fanlike manner posterior
to the medial malleolus.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1017.

Question 4

How would you anesthetize the sural nerve as part of

an ankle block?

Answer 4

The injection of 5-8 mL of local anesthetic posterior to the
lateral malleolus will block the sural nerve.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1017.

Question 5

The injection of local anesthetic subcutaneously from
the medial malleolus of the ankle to the extensor
digitorum longus tendons would anesthetize which
two nerves?

Answer 5

The injection of local anesthetic superficially near the medial
malleolus will anesthetize the saphenous nerve while the
continued injection toward the extensor digitorum longus tendon
will anesthetize the superficial peroneal nerve.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1017.

Question 6

When doing an ankle block, the injection of local
anesthetic between the flexor hallucis longus and the
extensor digitorum tendons just lateral to the anterior
tibial artery will anesthetize which nerve?

Answer 6

Injecting local anesthetic between the flexor hallucis longus and
the extensor digitorum tendons will anesthetize the deep
peroneal nerve.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1015-1017.

Question 7

The saphenous nerve is the terminal branch of what

nerve?

Answer 7

The saphenous nerve is the terminal branch of the femoral
nerve and can be blocked by injecting 5 mL of anesthetic
anterior to the medial malleolus.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1124