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Anterior Ankle Nerve BlockAka: Regional Anesthesia of the Anterior Ankle

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  1. Indications
    1. Anesthesia of the dorsum of the foot
  2. Precautions
    1. Avoid injecting directly into nerves
  3. Preparation
    1. Needle: 27 gauge 1.5 inch
    2. Anesthetic: Lidocaine 1%: two 10 ml syringes
  4. Technique
    1. Patient position
      1. Supine position
      2. Ankle slightly plantar flexed
    2. Injection site 1: Saphenous Nerve
      1. Identify site
        1. Superior and anterior to medial malleolus
      2. Inject 3 cc subcutaneously
    3. Injection site 2: Superficial peroneal nerve
      1. Identify site
        1. Anterior tibial border and
        2. Superior to lateral malleolus
      2. Inject 5 cc Lidocaine 1% subcutaneously
    4. Injection site 2: Deep peroneal nerve
      1. Identify site dorsiflexing ankle against resistance
        1. Between tibialis anterior and extensor hallucis l
        2. Approximately at level between malleoli
      2. Insert needle lateral to anterior tibial artery
        1. Aspirate and inject 5 cc Lidocaine 1%
    5. Warning: Distal Paresthesias with needle with injection
      1. Indicates needle is in nerve
      2. Do not inject here!
      3. Remove needle and reposition
  5. References
    1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
    2. Salam (2004) Am Fam Physician 69(4):896

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