Saphenous Nerve Block

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
Editor(s): Lee A. Fleisher, MD, FACC, FAHA Lee A. Fleisher, MD, FACC, FAHA

Robert Dunning Dripps
Professor and Chair
Department of Anesthesiology and Critical Care

Professor of Medicine
University of Pennsylvania School of Medicine
| Robert Gaiser, MD Robert Gaiser, MD

Professor of Anesthesiology and Critical Care
Department of Anesthesiology and Critical Care
University of Pennsylvania School of Medicine

Contributor(s): Acknowledgements Acknowledgements

VIDEO EDITOR
Jeremy D. Kukafka, MD
Faculty
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA

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Psoas Compartment Block: Ultrasound-Guided Technique
Supraclavicular Nerve Block: Ultrasound-Guided Technique


MEDICAL WRITER
Gail A. Van Norman, MD
Clinical Associate Professor
Department of Anesthesiology
Univ of Washington
Seattle, WA

MEDICAL AND VIDEO EDITOR AND SUBJECT MATTER EXPERT
Elizabeth J. Watson, MD
Post-Doctoral Fellow
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA

VIDEO COORDINATOR
Liang Xue, BS
Research Assistant
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA
| Kenneth A. Richman, MD Kenneth A. Richman, MD

Assistant Professor of Clinical Anesthesiology and Critical Care, Associated Faculty of the University of Pennsylvania School of Medicine

PRE-PROCEDURE
INDICATIONS
  • Surgery on the lower leg: orthopedic, podiatric, vascular procedures (medial, anteromedial, and posteromedial aspect of lower leg from just below the knee to the foot)
  • Postoperative pain relief for major corrective foot surgery (when combined with popliteal nerve block)
CONTRAINDICATIONS
  • Absolute contraindications
    • Patient refusal
    • Infection of the skin area over the area to be injected
  • Relative contraindications
    • Preexisting neuropathy
    • Trauma to lower extremity nerves
  • Because the block is relatively noninvasive, coagulopathy is not necessarily a contraindication to its performance. There is a very low incidence of complications.
EQUIPMENT
  • Appropriate equipment for resuscitation, including oxygen, suction, and appropriate medications
  • 1.5-inch, 25-gauge block needle
  • 10-mL syringe
  • Local anesthetic, 10 mL (e.g., 0.5 % ropivacaine, 2% lidocaine, 0.5% bupivacaine)
  • Sterile prep solution
  • Sterile gloves and mask
ANATOMY

The saphenous nerve is a branch of the femoral nerve and becomes the sensory cutaneous branches below the knee. It travels down alongside the medial aspect of the knee behind the sartorius muscle and becomes deep subcutaneous below the knee. It descends alongside the long saphenous vein on the medial tibial border. At the distal end of the lower leg, it continues to the medial malleolus. Along its subcutaneous path, the saphenous nerve has numerous small branches that make isolation of a single part of the nerve difficult. Blockade for foot surgery is best achieved at the ankle region near the medial malleolus.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • This is a minimally invasive procedure that requires no special postoperative care. If a hematoma forms because of accidental puncture of the saphenous vein, apply local steady pressure.
COMPLICATIONS
  • Local anesthesia toxicity
    • Not likely because of the small volume of local anesthetic used and peripheral location of the injection. Toxicity is possible if this block is combined with other simultaneous regional blocks that result in a large total volume of injected anesthetic solution
  • Hematoma formation due to puncture of the saphenous vein
  • Nerve injury due to intraneural injection (usually accompanied by pain in the nerve distribution when the local anesthetic is injected)
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