Regional Anaesthesia for Foot and Ankle Surgery Flashcards
1
Q
Nerve supply to the foot and ankle
A
- Saphenous nerve- terminal branch of femoral nerve, supplies the medial aspect of the foot and ankle
- Superficial peroneal nerve- supplies the dorsum of the foot apart from 1st and 2nd toe web space
- Deep peroneal- supplies the 1st and 2nd toe web space
- Sural nerve- plantar and lateral aspect of the foot
- Tibial nerve- supplies the sole of the foot
2
Q
Sciatic nerve block
A
- Commonly performed in the popliteal fossa
- Position the patient laterally or prone
- Scan from the crease of the knee and identify the popliteal artery
- The tibial nerve lies posterior to this
- Scan up until you see the common peroneal nerve joining the tibial nerve
- Perform the block at the point these two nerves join in a common perineural sheath
- 20ml LA
3
Q
Tibial nerve block
A
- Position the patient laterally
- Place USS 5cm above the medial malleolus
- 5ml LA, biggest nerve takest the longest onset time therefore block first
4
Q
Deep peroneal nerve block
A
- Foot supine
- USS probe on dorsum of foot
- Identify the tibial artery
- Nerve lies lateral to this
- 1-3ml of LA
5
Q
Superficial peroneal nerve block
A
- Position patient with leg internally rotates
- Scan up from the lateral malleolus identifying the fibula
- Superficial peroneal nerve lies in fascia surrounded by fibularis longus and brevis muscles
- 1-3ml of LA
6
Q
Sural nerve block
A
- Position laterally scan up from the lateral malleolus
- Identify the short saphenous vein anterior to the Achilles tendon
- Nerve runs in this fascia
- 1-3ml of LA
7
Q
Saphenous nerve block
A
- Foot lateral
- Probe above the medial malleolus (v light pressure) to identify the long saphenous nerve
- Nerve runs in the same fascial sheath as this but is often very difficult to identify
- 5ml of LA around the vein should block the saphenous if not identified
- Alternatively adductor canal block
