Advantages And Disadvantages Of Landmark Guided Ankle Block

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Introduction
Ankle block is an extremely useful regional technique for providing analgesia and anesthesia for foot surgery.[1] When compared to other regional anesthetic techniques such as sciatic block or a spinal anesthetic, the ankle block offers several advantages including the preservation of motor function, the ability to ambulate and a low risk of serious complications.[2,3] It is of particular use in patients who may be at higher risk of complication from a general anesthetic, and in whom performing a spinal anesthetic may be technically challenging[4] or relatively contraindicated. The application of ultrasound guidance has eliminated the traditional limitations of the ankle block such as procedural pain and variable block success. In this article, we review the practical aspects surrounding the use of ultrasound guided ankle block and conclude by outlining the technical aspects of performing it.

Limitations of ‘Landmark guided ankle block’
While the ‘Landmark guided ankle block’ approach has been in use for a long time, it has several disadvantages which contribute to suboptimal success rates. In a randomized controlled trial of landmark guided ankle block versus proximal sciatic block, McLeod et al found up to 16% of patients who received LGAB required rescue morphine in the post-operative recovery …show more content…

Alternatively, rolled up blankets or pillows may be used to elevate the leg if a bolster is not available. To access the nerves on the medial aspect of the ankle (the tibial nerve and the saphenous nerve), the leg is flexed at the knee and externally rotated at the hip. For the deep peroneal nerve, the leg is placed in a neutral position, while for the nerves on the lateral aspect of the ankle (i.e. the superficial peroneal nerve and the sural nerve), the knee is flexed and the hip internally

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