Name:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Ankle Block
Description:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Ankle Block
Thumbnail URL:
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Duration:
T00H07M24S
Embed URL:
https://stream.cadmore.media/player/2dd4c90e-c506-47df-9e08-0082427befc2
Content URL:
https://asa1cadmoremedia.blob.core.windows.net/asset-4d30e516-91bc-44e0-91f6-c20aa89f37a0/ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided An.mov
Upload Date:
2022-02-23T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DIGITAL INTRO TUNE:
DR. HADZIC: An ankle block, and again, the most important nerves for this particular operation are the tibial nerve which anesthetizes most of that territory of our interest, and then the deep peroneal nerve. Saphenous nerve is really not necessary always because it reaches this area here only in a minor percentage of patients. So yes, you can also do a saphenous nerve block, but you also could do a simple infiltration proximal to the site of surgery which is sufficient in most cases.
DR. HADZIC: So because the tibial nerve is the largest of the nerves that we're interested in blocking, we're going to actually block that first to allow sufficient time for the block to onset. So, what we are really focusing now on the ultrasound image is, we would like to find an image where we can see the nerve in its compartment that is conducive for blockade because as we talked about, nerve block is a block or injection of the local anesthetic into the space that contains the nerve.
DR. HADZIC: So in the ultrasound now what we see is the medial malleolus, this is the medial retinaculum. Here we can see the posterior tibial artery and the veins, and in that compartment is actually the tibial nerve. So what we aim to do is to place a needle into that compartment, and if the injection is successful, then we would see the local anesthetic pushing the nerve away, indicating that we have injected into the space that contains the nerve.
DR. HADZIC: Okay. So we can get started. Most of the time, it is really not actually Most of the time, it is really not actually possible or convenient to do this block using an in-plane technique because the needle always encounters the bone, but out-of-plane technique is the most common method that we actually utilize. So, the needle should be now in a position where we want it to be.
DR. HADZIC: We have, I believe, passed the medial retinaculum. If not, there we go. We just entered the space where the nerve is contained. And now there comes the test. Aspiration is negative. Response we can't obtain, because we don't have a nerve stimulator now. And the opening injection pressure to get started is low. Okay. So here we can see the local anesthetic how it displaces the nerve.
DR. HADZIC: Every time you see a displaced nerve by the local anesthetic, then you know that you're in that space. Here we can see the tip of the needle, and the only time we will move that tip of the needle in another location is if we actually create a space with the local anesthetic in which we just place the needle a little deeper into that space with the local, to make sure that it doesn't actually accidentally get out of the space.
DR. HADZIC: And again, every time we start an injection, the injection pressure is low, but you can see how the local anesthetic injected there basically just filled that space with the local anesthetic. So, we have injected into that space and again, a demonstration how a nerve block really is an injection of the local anesthetic into the space that contains the nerve. Next comes the deep peroneal nerve.
DR. HADZIC: To get a deep peroneal nerve image, it is crucially important not to apply excessive pressure. If you apply excessive pressure which we will demonstrate right now, you can see how we will obliterate the dorsalis pedis artery. So try one more time. Press. See the artery tends to go away completely, and then it becomes almost impossible to actually visualize the main anatomical landmark which is the artery itself.
DR. HADZIC: The nerve will always be on the lateral side of the artery in 95% of the times. And as you scan proximal or distal, the nerve tends to actually climb over the lateral wall of the artery. Let's see that one more time, there it is. Okay. There's a 25-gauge needle approaching the nerve. You want to be in that particular plane right here.
DR. HADZIC: That's good. Okay. Very good, so that's what we want. Superficial peroneal nerve. Good, so this is what we see. We see the lateral compartment, we see the anterior compartment, we can see the fibula here, and in here, we are looking to see that-- There you go. These are the branches of the superficial peroneal nerve.
DR. HADZIC: Yes. Good. Right there as well. Right there is the main trunk so we want to inject into that space and get the block of the superficial peroneal nerve. Again, options are here also, you can do in-plane, out-of-plane, we opted here to do an out-of-plane approach.
MACHINE BEEPING THE BACKGROUND: Okay. Yeah. Good. We go through the fascia's top, and basically just fill that space with the local. There you go. We peel that little branch, but we still need to get to the main trunk here. Little bit more anterior, yes, pass without going through the nerve. That's good. Okay. That's a bit more. Perfect. Okay.
MACHINE BEEPING THE BACKGROUND: So that's the nerve right there now surrounded by the local anesthetic. What we also need to do is the sural nerve, for sure. So we're going to do one last injection for the sural nerve. Okay. So again, very light pressure is necessary in order for us to see the lesser saphenous vein which is in this situation over here.
MACHINE BEEPING THE BACKGROUND: Let's just establish the contact with the skin. Okay. Good. A little less of a pressure. Okay. So that's the lesser saphenous vein, and this could be the nerve.
BACKGROUND MUSIC:
BACKGROUND MUSIC: Okay. That's all that it takes. Okay. So that's the nerve right underneath the vein. So all it takes is really a couple of milliliters of local aesthetic. And there you go, mission accomplished. Target-specific ankle block for osteotomies of the hallux valgus surgery and osteotomies of the second and third toes.
DIGITAL OUTRO TUNE:
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