Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S3 E15: "Plenty of sole, and lots of kick: Blocks for foot and ankle surgery"
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Sep 30, 2025 Explore the intricacies of foot and ankle anesthesia! Discover a range of blocks, from digital to popliteal sciatic. Learn about pain expectations for various surgeries like bunions and fractures. Listen to insights on ultrasound techniques and the advantages of nerve stimulation. Dive into the humorously shared experiences of the hosts, while debating tourniquet pain management and local infiltration strategies. Plus, hear about innovative methods like WALANT for awake surgeries and the use of liposomal bupivacaine for lasting relief!
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Ultrasound-Guided Ankle Block Steps
- For an ultrasound-guided ankle block, scan dynamically and block tibial first (5 mL), then saphenous, deep peroneal, superficial peroneal, and sural as needed.
- Use 10–20 mL total local, tailoring volumes to visibility and target nerves rather than fixed high volumes.
Landmark Ring Ankle Block Option
- Learn the landmark (ring) ankle block for environments without ultrasound; target tibial first then subcutaneous ring for superficial nerves and a small injection at the extensor retinaculum for deep peroneal.
- Keep needle depth shallow and aspirate to avoid intravascular injection.
Get Inside The Popliteal Sheath
- Popliteal sciatic works best when the needle enters the common paraneural sheath combining tibial and common peroneal components.
- Being inside that sheath (the 'pants crotch' zone) is the critical factor for reliable block spread and success.