Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants

Benimeli-Fenollar, María; Montiel-Company, José María; Almerich‐Silla, José Manuel; Cibrián, Rosa; Macián-Romero, Cecili

doi:10.3390/ijerph17113860

Cited by 7 publications

(4 citation statements)

References 19 publications

(28 reference statements)

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“…A controlled study with a placebo injection with more patients and with special attention to plantar pressure is more appropriate to appraise the consequences of tibial nerve block in persistent foot pain and the manner of walking. This study used a classic anatomical landmark guided block technique for tibial nerve block with a volume of local anesthetic of more than 3 mL for a better success rate ( 20 ). An ultrasound-guided block technique can achieve more successful nerve blocks ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Tibial Nerve Block as Treatment of Chronic Foot Pain

Ritt

Koning²,

Dalen

et al. 2023

Anesth Pain Med

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Background: Minimally invasive therapies can alleviate pain and improve walking in individuals with persistent foot and ankle pain. Objectives: The current study aimed to define the protracted consequences of tibial nerve blocks with steroids for individuals with persistent foot pain and to investigate the link between the thermography of the plantar foot and the beneficial effect of a tibial nerve block with steroids. Methods: All patients with chronic foot pain (n = 45) in this cohort underwent a block of the tibial nerve in the Department of Pain Therapy of Pain Clinic De Bilt, Utrecht, Netherlands, within November 2019 to April 2020. The thermographic images of patients were taken before and after injection. Results were retrospectively evaluated after 18 months. Results: In this study, 53% of the patients had pain relief at 7 weeks of follow-up with a unilateral or bilateral block of the tibial nerve. An improvement in walking distance was reported by 22% of the patients. Side effects of the tibial nerve block reported at 7 weeks of follow-up increased pain (5%) and the occurrence of leg cramps (5%) among the treated patients. At 18 months, 45% of the successfully treated feet still had benefits. A difference between the big toe’s temperature and the foot’s average temperature of less than -0.9°C on thermography before and after the tibial nerve block can predict a beneficial result of therapy. Conclusions: Tibial nerve block provides a safe, minimally invasive treatment option for almost half of the patients with painful feet in this cohort, and when successful, it can last a long term. Thermographic imaging of the plantar foot can predict only to a small extent the beneficial effect of the tibial nerve block with steroids on foot pain. Tibial nerve block should be considered when custom foot orthoses have been inadequate for pain relief or restricted walking distance.

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Section: Discussionmentioning

confidence: 99%

Tibial Nerve Block as Treatment of Chronic Foot Pain

Ritt

Koning²,

Dalen

et al. 2023

Anesth Pain Med

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“…The PTN block is a well described and thoroughly examined nerve block that is accessible to clinicians of different training levels and experience. 7 , 8 , 15 In the series we report, it was performed by first- and third-year emergency medicine residents under the guidance of an ultrasound-trained faculty member. Emergency departments in colder climates frequently see frostbite as a chief complaint, and this case series can help guide the use of PTN blocks for pain control in such patients.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Posterior Tibial Nerve Block for Frostbite of the Plantar Surfaces: A Case Series

Burl

Latshaw

Dreyfuss

2022

Clinical Practice and Cases in Emergency Medicine

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Introduction: Frostbite is a painful condition that requires rapid identification and wound care to optimize outcomes. The posterior tibial nerve (PTN) block, however, has yet to be described in the literature for pain control of frostbite injuries on the plantar surfaces. Case Series: In this case series we discuss three patients who presented with bilateral frostbite on the plantar surfaces. Ultrasound-guided PTN blocks were performed on these patients and pain control was achieved in under 10 minutes, facilitating burn care. No patient experienced adverse effects. All patients had been scheduled for future debridement that was either not performed or performed using intravenous (IV) medications due to pain control issues. Conclusion: The ultrasound-guided PTN block facilitated proper wound debridement that was previously intolerable with oral and IV pain medications. This case series highlights the efficacy, safety, and accessibility of this block for frostbite pain control in the emergency department. Additionally, it emphasizes the potential role of ultrasound-guided PTN blocks as part of a multi-modal pain control strategy in other clinical settings.

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“…9 Tibial nerve block (TNB) is recommended as it includes just the tibial nerve component of the sciatic nerve and produces less block of the common peroneal nerve (CPN). 10 However, the proximal distribution of local anesthetic (LA) to the sciatic nerve might result in unwanted motor blockade. 11 Nowadays, ultrasound (US) guided LA infiltration of the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) provides adequate posterior knee analgesia by targeting only the genicular stems of the sciatic nerve with no effect on the motor function.…”

Section: Introductionmentioning

confidence: 99%

A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty

Abogabal,

Zahra,

Abdel-Elsalam

et al. 2023

Anaesth. pain intensive care

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Background & Objective: Postoperative pain after total knee arthroplasty (TKA) is a significant factor influencing the surgical outcome. Adductor canal block (ACB) has no analgesic effect on the posterior knee capsule, which is innervated by the terminal branches of the tibial nerve and the posterior branch of the obturator nerve. We compared ACB plus IPACK block (infiltration of the interspace between the popliteal artery and the posterior capsule of the knee) versus ACB with selective tibial nerve block (TNB) for pain management after TKA. Methodology: We enrolled 70 patients, aged 40-80 y, body mass index of 18.5-35 kg/m2, scheduled for TKA in the study. Patients were randomly allocated to one of the two equal groups; Group 1 to receive ACB with IPACK block and Group 2 to receive ACB with TNB. Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were noted in both groups. The 0-10 numeric rating scale (NRS) was used to measure the pain intensity in the patients. Results: Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were significantly increased in Group 2 than in Group 1 (P < 0.001). The numeric rating scale was significantly lower in Group 2 at 8 h only but was comparable in other measurements. Range of motion and the strength of quadriceps were comparable between both groups at 24, 48, and 72 h postoperatively. Conclusions: Adductor canal block with IPACK preserved motor function better and reduced the time to ambulation and hospital stay compared to tibial nerve block with adductor canal block. However, adductor canal block with selective tibial nerve block prolongs sensory block, the time to first analgesia request, and reduces postoperative opioid consumption at first 24 h. Both methods had a comparable effect on quadriceps strength. Abbreviations: ACB - Adductor Canal Block; IPACK - Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee; TNB - Tibial Nerve Block; TKA - Total Knee Arthroplasty Key words: Total Knee Arthroplasty; Adductor Canal Block; IPACK; Selective Tibial Nerve Block. Citation: Abogabal MA, Zahra SW, Abdel-ElsalamWM, Wafaa Madhy Abdelwahed WM. A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty. Anaesth. pain intensive care 2023;27(5): 567−574. DOI: 10.35975/apic.v27i5.2313 Received: July 25, 2023; Reviewed: August 18, 2023; Accepted: August 26, 2023

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Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants

Cited by 7 publications

References 19 publications

Tibial Nerve Block as Treatment of Chronic Foot Pain

Tibial Nerve Block as Treatment of Chronic Foot Pain

Ultrasound-Guided Posterior Tibial Nerve Block for Frostbite of the Plantar Surfaces: A Case Series

A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty

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