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

ABSTRACT

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.