To perform this block, the patient is placed in a supine position with the operative leg extended. Identify the extensor longus tendon by having the patient extend the big toe against resistance. With an aseptic technique a 25 g 1.5 in. needle is inserted at a point just medial to the tendon at the skin crease of the ankle. After negative aspiration a total of 7-8 cc of local is slowly injected with the needle aiming toward the medial malleolus.
Pitfalls and Pearls Pitfalls
• Intravascular injection
• Presence of femoral vascular grafts is a relative contraindication
• If no response to the nerve stimulator is obtained, then the needle is moved either medial or lateral from the initial insertion site in a logical and sequential manner. The changes should occur by 0.5 cm increments
• A sartorius muscle twitch alone is usually not acceptable, but by passing the needle deeper to this twitch will often evoke a patella twitch which is acceptable
• If bone is contacted (pubic bone) the needle has been inserted too deep
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