Ultrasound Improves the Success Rate of a Tibial Nerve Block at the Ankle

Abstract

In healthy volunteers, US guidance results in a more successful tibial nerve block at the ankle than does a traditional approach using surface landmarks.

Ultrasound Does Not Improve the Success Rate of a Deep Peroneal Nerve Block at the Ankle

“…The primary outcome of this study was the presence of a partial or complete sensory block in the web space between the first and second toes. On the basis of extrapolating the results from our sural and tibial nerve study, 8,9 we hypothesized a success rate of 95% in the US group and 50% in the LM group. With a power of 0.8, a type I error rate of 0.05, and the use of a nonparametric sign rank test, 18 subjects were required for the paired comparison in which each subject served as his or her own control.…”

“…It does not, however, seem to improve the overall quality of the block when compared with a traditional landmark technique. Applying the same methodology from our previous studies wherein ultrasound improved the quality of the sural and tibial nerve blocks at the ankle, 8,9 we hypothesized that ultrasound would also improve the overall quality of a deep peroneal block. One possible explanation for the similar quality between groups is that the tendons of extensor hallucis longus and tibialis anterior muscles represent unequivocal landmarks, thus facilitating effective traditional block placement.…”

“…Our previous studies demonstrated that ultrasound improves the success rate for both sural and tibial nerve blocks at the ankle. 8,9 Given the lack of evidence-based medicine surrounding deep peroneal nerve blocks, our primary objective was to compare a conventional, landmark-based technique to an image-based technique using high-frequency ultrasound. We hypothesized that ultrasound would increase both the success rate and the quality of a deep peroneal nerve block at the ankle.…”

Ultrasound-Guided Regional Anesthesia and Patient Safety

“…Because HDP can still occur unpredictably, caution remains warranted in any patient unable to withstand a 30% diminution of pulmonary function (IV 30 and a volunteer who had a dysesthesia of the tibial nerve, which was present but improving after 2 months (this subject is included in the RCTs). 31 In summary, limited literature and small patient numbers suggest 3 findings concerning peripheral nerve injury and UGRA: (1) block-related paresthesia, a surrogate outcome at best, was not reduced when similar block groups were compared; (2) RCTs and large case studies report no permanent neurologic injuries, nevertheless; and (3) peripheral nerve injury associated with, but arguably unrelated to, UGRA has been reported. Because the examined RCTs were not powered to assess nerve injury, the best data on this topic come from the large case series, thereby providing level III strength of evidence (Table 3).…”

Ultrasound-Guided Interventional Procedures in Pain Medicine

“…The TN is a hyperechoic round structure that is often, but not always, posterior to the posterior tibial artery, which is pulsatile. 24 The TN is scanned proximal and distal to the medial malleolus in short axis to attempt to identify the calcaneal, medial, and lateral branches, which are not always visible (Fig. 7).…”