Saphenous Nerve Block at the Ankle

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

• Paresthesia

• Presence of femoral vascular grafts is a relative contraindication

Pearls

• 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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