Regional Anesthesia of Lower Extremity using Tibial Nerve and Saphenous Nerve Block

Lower leg reconstruction has been performed with greater frequency under general or spinal anesthesia. But for patients with difficult problem in general or spinal anesthesia such as myocardial ischemia and end-stage renal failure, regional block techniques have been advocated. The regional block involved the tibial and saphenous nerve is performed as the following; two points of insertion of the needle are defined in lateral to popliteal pulsation and posterior to medial femoral condyle. We use 10cc of 0.25% bupivacaine for popliteal area block and 10cc of it for saphenous nerve block. In these techniques the major landmark for needle insertion is the popliteal artery. In all patients(19 cases) the techniques formed part of lower leg block for lower leg reconstruction. It was successful in 18 cases except in one case which failed initially but was successful at the following trial. There were no complications associated with these techniques. There were no incidents of postoperative neuralgia or neuropraxia. Lower leg anesthesia with saphenous nerve block and tibial nerve block offers numerous advantages that make it a suitable anesthetic technique. These facts suggest that the performances of these blocks are safe and effective anesthetic technique for lower leg reconstruction.

Clinical Effects of Posterior Tibial Nerve Block with Diluted Phenol Solution

The posterior tibial nerve was partially blocked with 7% phenol solutions for the relief of severe spasticity in cerebral palsy and brain injured patients. Forty patients were included in this study. Among them thirty five patients were cerebral palsy and five patients were brain injured. A phenol injection was performed to the posterior tibial nerve at the popliteal fossa with the patients in a prone position. Total injected dose in each patient was 0.40 to 4.00 cc (average 2.06 0.96 cc). The dose was far below the toxic level and no significant side effects were noted except for a few cases of local paresthesia and tenderness. The range of dorsiflexion of the ankle was increased and the gait pattern improved in most of the patients one month after the injection. The H-reflex latency was prolonged after the injection compared with the pre-injection latency. The phenol injection can greatly facilitate the rehabilitation process of the patient by reducing the need for physical therapy and bracing, increasing the patient's ambulation ability, and decreasing the development of secondary leg deformities. In conclusion, with the easiness, simplicity, safety, low cost, and a selective reduction of spasticity in the group of muscles, the remarkable therapeutic benefits of posterior tibial nerve blocked with 7% phenol solutions warrant the more widespread use of this technique in younger cerebral palsy patients before developing fixed soft tissue contractures.