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Landmark Technique vs Ultrasound-Guided Approach for Posterior Tibial Nerve Block in Cadaver Models
Ashish Shah1, Sara Morris2, Bradley Alexander1
11Division of Foot and Ankle, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL 35205 USA.
Indian Journal of Orthopaedics
|March 27, 2020
Summary
Ultrasound guidance significantly improves the accuracy of posterior tibial nerve (PTN) blocks compared to traditional anatomical landmarks. This study demonstrated a 100% success rate with ultrasound, compared to 40% with landmarks, for dye spread in cadaver models.
Area of Science:
- Regional Anesthesia
- Ultrasound-Guided Procedures
- Anatomy
Background:
- Ultrasound enhances peripheral nerve block accuracy and efficacy.
- Ankle blocks, crucial for foot/ankle procedures, have lagged in ultrasound adoption.
- This study addresses the need for improved ankle block techniques.
Purpose of the Study:
- Compare ultrasound-guided vs. landmark-guided ankle blocks.
- Assess injectate spread along the posterior tibial nerve (PTN).
- Evaluate accuracy in cadaver models.
Main Methods:
- Ten below-knee cadaver specimens were used.
- Five underwent landmark-guided PTN blocks; five received ultrasound-guided blocks.
- 2 mL of acrylic dye was injected, followed by dissection to assess nerve coating.
Main Results:
- 100% of ultrasound-guided blocks successfully coated the PTN with dye.
- Only 40% of landmark-guided blocks achieved PTN dye coating.
- Unsuccessful landmark attempts resulted in misplaced dye (posterior to PTN or in tendons).
Conclusions:
- Ultrasound guidance is superior for ankle blocks.
- Demonstrates a 100% success rate for accurate dye delivery to the PTN.
- Supports increased evidence for ultrasound in regional anesthesia.
