Ankle Block

Artemus Flagg II, M.D., M.P.H.
Anesthesiology Resident

Calvin Eng, M.D.
Instructor

Vineesh Mathur, M.D.
Assistant Professor

Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Baltimore, Maryland

Introduction - TOP

An ankle block represents a regional anesthetic technique designed to provide surgical anesthesia for many types of foot operations. It is principally an infiltration block and does not require elicitation of paresthesias.1  There are many advantages of the ankle block technique, which include: 1) technical ease, 2) high safety factor with minimal side effects, 3) near 100% success rate,2 4) typically does not require multiple injections, and 5) can be taught to the relatively unskilled.3 

To decrease procedure related pain and anxiety, a combination of a short acting benzodiazepine and a narcotic, given in titrated doses, is recommended. In diabetic patients with severe neuropathy, the absence of normal sensation does not preclude the use of the ankle block procedure. When ankle blocks are necessary in these patients, their efficacy may actually be enhanced because of the preexisting diminished sensation in the affected foot.4

Ankle blocks can provide reliable anesthesia for foot surgery in patients with multiple medical problems. The block is devoid of any major physiological consequences that may be associated with axial or more central blocks.5  Even though ankle blocks are often recognized as “volume” blocks due to the administration of a large volume of local anesthetic to achieve a complete block, a lower concentration of local anesthetic may be utilized because motor blockade is often not needed for the surgical procedure.

Read More >>