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<br /> Ultrasound<br /> Ultrasound-guided ankle block<br /> Philips tutorial<br /> Saravanan P. Ankichetty, MBBS, MD, DA, MBA<br /> Ki Jinn Chin, MBBS, MMED, FANZCA, FRCPC<br /> Vincent Chan, MD, FRCPC, FRCA<br /> Department of Anesthesia, Toronto Western Hospital<br /> University of Toronto, Toronto, Ontario, Canada<br /> Contents<br /> Ultrasound-guided ankle block<br /> 1 Introduction 3<br /> 2 Equipment and drugs 4<br /> 3 Patient preparation and positioning 5<br /> 4 Gross anatomy 6<br /> 5 Tibial nerve 8<br /> 6 Deep peroneal nerve 15<br /> 7 Superficial peroneal nerve 22<br /> 8 Sural nerve 29<br /> 9 Saphenous nerve 34<br /> 10 References 3<a title="US-Guided Ankle Block tutorial_FNL page 1" href="http://viewer.zmags.com/publication/a587b76a?page=1"> Ultrasound Ultrasound-guided ankle block Philips</a> <a title="US-Guided Ankle Block tutorial_FNL page 2" href="http://viewer.zmags.com/publication/a587b76a?page=2"> Contents Ultrasound-guided ankle block 1 </a> <a title="US-Guided Ankle Block tutorial_FNL page 3" href="http://viewer.zmags.com/publication/a587b76a?page=3"> 1 Introduction The ankle block is a suitab</a> <a title="US-Guided Ankle Block tutorial_FNL page 4" href="http://viewer.zmags.com/publication/a587b76a?page=4"> 2 Equipment and drugs • Ultrasound system </a> <a title="US-Guided Ankle Block tutorial_FNL page 5" href="http://viewer.zmags.com/publication/a587b76a?page=5"> 3 Patient preparation and positioning </a> <a title="US-Guided Ankle Block tutorial_FNL page 6" href="http://viewer.zmags.com/publication/a587b76a?page=6"> 4 Gross anatomy A thorough understanding of </a> <a title="US-Guided Ankle Block tutorial_FNL page 7" href="http://viewer.zmags.com/publication/a587b76a?page=7"> Saphenous Common medial peroneal (L4-S2) (L3-4) </a> <a title="US-Guided Ankle Block tutorial_FNL page 8" href="http://viewer.zmags.com/publication/a587b76a?page=8"> 5 Tibial nerve Anatomical relationship The t</a> <a title="US-Guided Ankle Block tutorial_FNL page 9" href="http://viewer.zmags.com/publication/a587b76a?page=9"> Sensory innervation The tibial nerve supplies the</a> <a title="US-Guided Ankle Block tutorial_FNL page 10" href="http://viewer.zmags.com/publication/a587b76a?page=10"> The tibial nerve is usually located posterior to </a> <a title="US-Guided Ankle Block tutorial_FNL page 11" href="http://viewer.zmags.com/publication/a587b76a?page=11"> Flexor retinaculum FDL TP TN </a> <a title="US-Guided Ankle Block tutorial_FNL page 12" href="http://viewer.zmags.com/publication/a587b76a?page=12"> Needling approach An in-plane or out-of-plane nee</a> <a title="US-Guided Ankle Block tutorial_FNL page 13" href="http://viewer.zmags.com/publication/a587b76a?page=13"> TN MM Needle M PA LA </a> <a title="US-Guided Ankle Block tutorial_FNL page 14" href="http://viewer.zmags.com/publication/a587b76a?page=14"> [ Video 1] Video demons</a> <a title="US-Guided Ankle Block tutorial_FNL page 15" href="http://viewer.zmags.com/publication/a587b76a?page=15"> 5 Deep peroneal nerve Anatomical relationshi</a> <a title="US-Guided Ankle Block tutorial_FNL page 16" href="http://viewer.zmags.com/publication/a587b76a?page=16"> Sensory innervation The medial branch gives senso</a> <a title="US-Guided Ankle Block tutorial_FNL page 17" href="http://viewer.zmags.com/publication/a587b76a?page=17"> [Figure 6] Transducer positioned over the anterio</a> <a title="US-Guided Ankle Block tutorial_FNL page 18" href="http://viewer.zmags.com/publication/a587b76a?page=18"> Needling approach An in-plane or out-of-plane nee</a> <a title="US-Guided Ankle Block tutorial_FNL page 19" href="http://viewer.zmags.com/publication/a587b76a?page=19"> [Figure 8] In-plane needle approach to the deep p</a> <a title="US-Guided Ankle Block tutorial_FNL page 20" href="http://viewer.zmags.com/publication/a587b76a?page=20"> [ Video 2a ] Video demo</a> <a title="US-Guided Ankle Block tutorial_FNL page 21" href="http://viewer.zmags.com/publication/a587b76a?page=21"> [ Video 2b ] Video demo</a> <a title="US-Guided Ankle Block tutorial_FNL page 22" href="http://viewer.zmags.com/publication/a587b76a?page=22"> 7 Superficial peroneal nerve Anatomical rela</a> <a title="US-Guided Ankle Block tutorial_FNL page 23" href="http://viewer.zmags.com/publication/a587b76a?page=23"> Sonoanatomy and nerve localization The patient’s </a> <a title="US-Guided Ankle Block tutorial_FNL page 24" href="http://viewer.zmags.com/publication/a587b76a?page=24"> The superficial peroneal nerve can be visualized </a> <a title="US-Guided Ankle Block tutorial_FNL page 25" href="http://viewer.zmags.com/publication/a587b76a?page=25"> SPN CF PM EDL Fibula L Tibia </a> <a title="US-Guided Ankle Block tutorial_FNL page 26" href="http://viewer.zmags.com/publication/a587b76a?page=26"> Needling approach The SPN nerve can be blocked ei</a> <a title="US-Guided Ankle Block tutorial_FNL page 27" href="http://viewer.zmags.com/publication/a587b76a?page=27"> SPN Needle CF LA PM EDL Fibula L Tibia </a> <a title="US-Guided Ankle Block tutorial_FNL page 28" href="http://viewer.zmags.com/publication/a587b76a?page=28"> [ Video 3 ] Video demon</a> <a title="US-Guided Ankle Block tutorial_FNL page 29" href="http://viewer.zmags.com/publication/a587b76a?page=29"> 8 Sural nerve Anatomical relationship The sur</a> <a title="US-Guided Ankle Block tutorial_FNL page 30" href="http://viewer.zmags.com/publication/a587b76a?page=30"> Sonoanatomy and nerve localization The patient’s </a> <a title="US-Guided Ankle Block tutorial_FNL page 31" href="http://viewer.zmags.com/publication/a587b76a?page=31"> The sural nerve may be visualized as a small hype</a> <a title="US-Guided Ankle Block tutorial_FNL page 32" href="http://viewer.zmags.com/publication/a587b76a?page=32"> Needling approach The sural nerve can be blocked </a> <a title="US-Guided Ankle Block tutorial_FNL page 33" href="http://viewer.zmags.com/publication/a587b76a?page=33"> [ Video 4 ] Video demon</a> <a title="US-Guided Ankle Block tutorial_FNL page 34" href="http://viewer.zmags.com/publication/a587b76a?page=34"> 9 Saphenous nerve Anatomical relationship The</a> <a title="US-Guided Ankle Block tutorial_FNL page 35" href="http://viewer.zmags.com/publication/a587b76a?page=35"> Sonoanatomy and nerve localization With the patie</a> <a title="US-Guided Ankle Block tutorial_FNL page 36" href="http://viewer.zmags.com/publication/a587b76a?page=36"> A tourniquet around the calf can enhance venous f</a> <a title="US-Guided Ankle Block tutorial_FNL page 37" href="http://viewer.zmags.com/publication/a587b76a?page=37"> Needling approach The saphenous nerve can be bloc</a> <a title="US-Guided Ankle Block tutorial_FNL page 38" href="http://viewer.zmags.com/publication/a587b76a?page=38"> [ Video 5 ] Video demon</a> <a title="US-Guided Ankle Block tutorial_FNL page 39" href="http://viewer.zmags.com/publication/a587b76a?page=39"> 10 References 1. Tryba M. Ankle block:</a> <a title="US-Guided Ankle Block tutorial_FNL page 40" href="http://viewer.zmags.com/publication/a587b76a?page=40"> Additional resources For additional resources</a> <a title="US-Guided Ankle Block tutorial_FNL page 41" href="http://viewer.zmags.com/publication/a587b76a?page=41"> This paper reflects the opinion of the author, no</a>