scholarly journals Landmark Technique vs Ultrasound Guided Approach for Posterior Tibial Nerve Block in Cadaver Models

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Sara Elizabeth Morris ◽  
Haley McKissack ◽  
Leonardo V. M. Moraes ◽  
Gean C. Viner ◽  
James R. Jones ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Medial Malleolus ◽  
Anatomical Landmarks ◽  
Posterior Tibial Nerve ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Posterior Tibial ◽  
Linear Probe ◽  
Landmark Technique ◽  
Regional Anesthetic

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Until recently, many regional anesthetic blocks were performed without the assistance of ultrasound, relying on methods such as anatomical landmarks and nerve stimulation. The use of ultrasound for peripheral nerve blocks has proven extremely useful for improving the efficacy of many regional anesthetic techniques. There remain a few nerve blocks which have lagged in employing the assistance of ultrasound consistently, one of which is the ankle block. This block is commonly utilized for either surgical anesthesia or post-operative analgesia for a variety of foot and ankle procedures. In this study, we compared the accuracy of traditional landmark technique with an ultrasound guided approach for ankle block by assessing the spread of injectate (dye) along the posterior tibial nerve (PTN) in cadaver models. Methods: Ten below-knee cadaver specimens were used for this study. Five were randomly chosen to undergo landmark guided PTN blocks, and five were selected for ultrasound-guided PTN blocks. The landmark technique was performed by identifying the medial malleolus and Achilles tendon and inserting the needle (4 cm long, 21G Braun® Stimuplex) at the midpoint of the two structures, aiming toward the medial malleolus and advancing until bone was contacted. 2 cc of blue acrylic dye was injected at this location. The ultrasound technique was performed with a linear probe identifying the medial malleolus and the PTN. The needle was advanced in-plane with a posterior to anterior trajectory until the tip of the needle was adjacent to the nerve. 2 cc of blue acrylic dye was injected surrounding the nerve. The extremities were then dissected to determine which nerves had been coated with dye. Results: 100% of the ultrasound guided blocks resulted in completely stained PTN with dye. In the landmark group, only 40% of the landmark technique blocks resulted in completely stained PTN with dye. Of the nerves not stained with dye, 2 were noted to have had dye injected posterior to the nerve and 1 was noted to have had dye injected into the flexor digitorum longus tendon. Conclusion: The base of evidence has dramatically increased in recent years in support of the use of ultrasound in regional anesthesia. This study substantiates the superiority of ultrasound guidance for ankle block by demonstrating a 100% success rate amongst the ultrasound guided group.

scholarly journals Landmark Technique vs Ultrasound-Guided Approach for Posterior Tibial Nerve Block in Cadaver Models

2020 ◽  
Vol 54 (1) ◽  
pp. 38-42
Author(s):  
Ashish Shah ◽  
Sara Morris ◽  
Bradley Alexander ◽  
Haley McKissack ◽  
James Rush Jones ◽  
...  
Keyword(s):  
Nerve Block ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Ultrasound Guided ◽  
Posterior Tibial ◽  
Landmark Technique

ED ultrasound-guided posterior tibial nerve blocks for calcaneal fracture analagesia

2016 ◽  
Vol 34 (6) ◽  
pp. 1183.e1-1183.e3 ◽  
Author(s):  
Eben Clattenburg ◽  
Andrew Herring ◽  
Christoper Hahn ◽  
Brian Johnson ◽  
Arun Nagdev
Keyword(s):  
Tibial Nerve ◽  
Calcaneal Fracture ◽  
Posterior Tibial Nerve ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Posterior Tibial

Tarsal Tunnel Syndrome Associated with a Pulsating Artery

2010 ◽  
Vol 100 (3) ◽  
pp. 209-212 ◽  
Author(s):  
Eunkuk Kim ◽  
Martin K. Childers
Keyword(s):  
High Resolution ◽  
Ultrasound Imaging ◽  
Tibial Nerve ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Tarsal Tunnel Syndrome ◽  
Ultrasound Guided ◽  
Nerve Ultrasound ◽  
Posterior Tibial ◽  
Tunnel Syndrome

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. (J Am Podiatr Med Assoc 100(3): 209–212, 2010)

Thermographic evaluation of the autonomic effects of nerve blocks in the foot

1989 ◽  
Vol 79 (3) ◽  
pp. 107-115
Author(s):  
AM Jacobs ◽  
R Esper ◽  
R O'Leary ◽  
ZM Duda ◽  
W Yorzyk
Keyword(s):  
Blood Flow ◽  
Nerve Block ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Nerve Blocks ◽  
Posterior Tibial ◽  
Bupivacaine Hydrochloride ◽  
Regional Nerve Block ◽  
Skin Temperatures ◽  
Increased Blood Flow

The authors evaluated regional skin temperatures of the foot following the administration of a variety of local anesthetic nerve blocks with either Xylocaine (lidocaine hydrochloride) or Sensorcaine (bupivacaine hydrochloride). The study was carried out on ten randomized parallel groups of five subjects, each group being tested with one drug and one regional nerve block. The results indicated that both Xylocaine and Sensorcaine, when administered as a posterior tibial block, result in a significantly increased blood flow to the foot. Nerve blockade of the remaining nerves of the foot did not significantly increase the sympatholytic effect obtained by posterior tibial nerve block alone.

scholarly journals Cadaveric Study of the Neurovascular Bundle in Tarsal Tunnel Region among Sudanese - 2020

2021 ◽  
Author(s):  
yasser seddeg ◽  
Elfarazdag Ismail
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Neurovascular Bundle ◽  
Medial Malleolus ◽  
Tarsal Tunnel ◽  
Nerve Blocks ◽  
Bifurcation Points ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Displacement Osteotomy

Abstract Background: Tarsal tunnel is situated medial to the ankle lying deep to the flexor retinaculum. Within which lies the neurovascular bundle in separate compartments. This study examines the level of bifurcation points of tibial nerve and posterior tibial artery, and the location of medial and lateral plantar nerves in the tarsal tunnel. As well as the origin of the medial calcaneal nerves. Methods: This study was a descriptive observational cross sectional study. Step by step dissections of the tarsal tunnel were performed on 30 Sudanese cadavers, the contents of the tarsal tunnel were explored. Results: The tibial nerve was found to bifurcate before the the medial malleolus calcaneal axis (MMCA) in (n=4/30, 13.3%) specimens , and inside the tunnel (n=26/30, 86.7%). The branching point of the posterior tibialartery was found before the MMCA in (n=10/28, 35.7%) of specimens, at the MMCA in (n=16/28, 57.1%), and after the MMCA in (n= 2/28, 7.1%). Medial calcaneal nerves were found to be derived from the LPN plus the TN in (n=13/30, 43.3%), while in (n=6/30, 20%) were derived from LPN plus MPN plus TN. only (n=5/30, 16.7 %) were derived from LPN alone. Conclusion: anatomical knowledge of the bifurcation points of tibial nerve and posterior tibial artery is of great importance in many medical procedures like external fixation of medial malleolus fractures, medial displacement osteotomy and nerve blocks in podiatric medicine.

scholarly journals Microneurography from the posterior tibial nerve: a novel method of recording activity from the foot in freely standing humans

2018 ◽  
Vol 120 (3) ◽  
pp. 953-959 ◽  
Author(s):  
T. P. Knellwolf ◽  
A. R. Burton ◽  
E. Hammam ◽  
V. G. Macefield
Keyword(s):  
Tibial Nerve ◽  
Human Subjects ◽  
Muscle Spindles ◽  
Cutaneous Afferents ◽  
Medial Malleolus ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial ◽  
Novel Approach ◽  
Tungsten Microelectrode ◽  
Intrinsic Muscles

The posterior tibial nerve, located behind the medial malleolus of the ankle, supplies the intrinsic muscles of the foot and most of the skin of the sole. We describe a novel approach for recording from this nerve via a percutaneously inserted tungsten microelectrode and provide examples of recordings from presumed muscle spindle endings recorded in freely standing human subjects. The fact that the angular excursions of the ankle joint are small as the foot is loaded during the transition from the seated position to standing means that one can obtain stable recordings of neural traffic in unloaded, loaded, and freely standing conditions. We conclude that this novel approach will allow studies that will increase our understanding of the roles of muscle and cutaneous afferents in the foot in the control of upright posture. NEW & NOTEWORTHY We have performed the first microneurographic studies from the posterior tibial nerve at the ankle. Stability of the recording site allows one to record from muscle spindles in the intrinsic muscles of the foot as well as from cutaneous mechanoreceptors in the sole of the foot during the transition from seated to standing. This novel approach opens up new opportunities for studying the roles of muscle and cutaneous afferents in the foot in the control of upright stance.

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