Abstract
Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time (p = 0.287), percentage of effective nerve blocks (p = 0.634), anesthetic block duration (p = 0.895), or pain level during puncture (p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals.
Highlights
Ankle blocking is a safe technique associated with a high success rate and a low risk of complications, and is very well accepted by both surgeons and patients [1]
The injection coordinates were obtained from prior ultrasound scans of the tibial nerve of 100 subjects in order to locate the were obtained from prior ultrasound scans of the tibial nerve of 100 subjects in order to locate the anatomical position of the tibial nerve at the retromalleolar and supramalleolar levels based on the anatomical position of the tibial nerve at the retromalleolar and supramalleolar levels based on the sex and the height of the subjects
These scans provided the anatomical coordinates for optimum sex and the height of the subjects. These scans provided the anatomical coordinates for optimum identification of the injection site for tibial nerve blocking (Table 1)
Summary
Ankle blocking is a safe technique associated with a high success rate and a low risk of complications, and is very well accepted by both surgeons and patients [1]. Its main advantage compared with a combined femoral and sciatic nerve block is that there is no motor blocking above the ankle. This facilitates rapid mobilization of the patient, which is a relevant consideration in outpatient surgery, in cases that require bilateral anesthetic procedures [2]. Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. Several studies have agreed in locating the bifurcation of the tibial nerve at the tarsal tunnel level in a great number of cases [3,4,5,6]. A number of publications [3,7,8,9]
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