In the Foot and Ankle Operation Theater

Chapter
4

In the Foot and Ankle Operation Theater

Time taken in planning the operation is the time reduced in carrying the operation!

Regional Anesthesia and Blocks

Tips and Tricks

♦ Done at least 30 minutes prior to the procedure for allowing some time for the anesthesia to take effect.

♦ Long-acting molecules take longer time to give effect.

♦ Take 30 mL of total solution with 10 mL of xylocaine and 20 mL of Marcaine and use a 22-gauge needle.

♦ Never use epinephrine.

♦ Use of sodium bicarbonate may speed up the onset of effect.

♦ Use of nerve stimulator or ultrasound would make procedure precise.

♦ Always aspirate before injecting.

♦ Be careful with the volume-tourniquet effect.

♦ Be cautious in cases with peripheral vascular diseases and diabetes.

♦ Take care in cases with infection where local anesthetic may not work due to acidotic effect, and there is a risk of infection spreading to healthy tissues.

Ankle Block

Surface anatomy of nerves in foot and ankle is depicted in Figs. 4.1 and 4.2. Important points to consider for ankle block are listed as follows:

Fig. 4.1 Surface anatomy of nerves in foot.

Fig. 4.2 Surface anatomy of nerves in ankle.

♦ Used for procedures at or distal to ankle.

♦ Five nerves are blocked:

• Tibial nerve

• Sural nerve

• Deep peroneal nerve

• Superficial peroneal nerve

• Saphenous nerve

Tibial nerve

Hold ankle dorsiflexed and put needle next to Achilles tendon at the level of ankle joint; direct it from posterior to anterior, advance to the bone, and withdraw 5 mm and inject 10 mL (Fig. 4.3).