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Interventional Radiology
Procedures
Pain Management Interventions
Lower Extremity
Acute Pain Procedures
Tibial Nerve Block
Tibial Nerve Block
Kimberly Ting, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Tibial nerve (TN)

            • Definitions

              • TN: Terminal branch of sciatic nerve
                • Branches into anterior and posterior TNs
              • TN receives contributions from L4, L5, S1, S2, and S3
                • Sensory innervation: Skin of posterolateral leg, lateral side of foot, and sole of foot
                  • Branches of TN cover sole of foot: Medial plantar nerve, lateral plantar nerve, medial calcaneal branches
                • Osseous innervation of medial femoral condyle, majority of tibia and fibula, and calcaneus
                • Motor innervation: Posterior compartment of lower leg
              • TN block can be performed by ultrasound-guided or landmark technique
              • Can be performed at level of ankle or popliteal fossa
              • Proximal to popliteal fossa, sciatic nerve branches into TN and common peroneal nerve
                • Posterior TN travels in posterior leg in close proximity to posterior tibial artery; mixed sensory and motor nerve
                • Distally: Posterior TN passes posterior to medial malleolus and posterior to posterior tibial artery at ankle
              • Duration of blockade depends on local anesthetic used
                • Mepivacaine yields 4-6 hours of analgesia
                • Bupivacaine yields 12-20 hours of analgesia

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Patient Position/Location

                      • Equipment Preparation

                        • Procedure Steps

                          • Findings and Reporting

                            • Alternative Procedures/Therapies

                              POST PROCEDURE

                              • Expected Outcome

                                • Things To Do

                                  • Things To Avoid

                                    OUTCOMES

                                    • Problems

                                      • Complications

                                        Selected References

                                        1. Kampitak W et al: Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. J Arthroplasty. 34(2):295-302, 2019
                                        2. Sinha SK et al: Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg. 115(1):202-6, 2012
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Preprocedure

                                            • Procedure

                                              • Post Procedure

                                                • Outcomes

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Tibial nerve (TN)

                                                  • Definitions

                                                    • TN: Terminal branch of sciatic nerve
                                                      • Branches into anterior and posterior TNs
                                                    • TN receives contributions from L4, L5, S1, S2, and S3
                                                      • Sensory innervation: Skin of posterolateral leg, lateral side of foot, and sole of foot
                                                        • Branches of TN cover sole of foot: Medial plantar nerve, lateral plantar nerve, medial calcaneal branches
                                                      • Osseous innervation of medial femoral condyle, majority of tibia and fibula, and calcaneus
                                                      • Motor innervation: Posterior compartment of lower leg
                                                    • TN block can be performed by ultrasound-guided or landmark technique
                                                    • Can be performed at level of ankle or popliteal fossa
                                                    • Proximal to popliteal fossa, sciatic nerve branches into TN and common peroneal nerve
                                                      • Posterior TN travels in posterior leg in close proximity to posterior tibial artery; mixed sensory and motor nerve
                                                      • Distally: Posterior TN passes posterior to medial malleolus and posterior to posterior tibial artery at ankle
                                                    • Duration of blockade depends on local anesthetic used
                                                      • Mepivacaine yields 4-6 hours of analgesia
                                                      • Bupivacaine yields 12-20 hours of analgesia

                                                  PREPROCEDURE

                                                  • Indications

                                                    • Contraindications

                                                      • Preprocedure Imaging

                                                        • Getting Started

                                                          PROCEDURE

                                                          • Patient Position/Location

                                                            • Equipment Preparation

                                                              • Procedure Steps

                                                                • Findings and Reporting

                                                                  • Alternative Procedures/Therapies

                                                                    POST PROCEDURE

                                                                    • Expected Outcome

                                                                      • Things To Do

                                                                        • Things To Avoid

                                                                          OUTCOMES

                                                                          • Problems

                                                                            • Complications

                                                                              Selected References

                                                                              1. Kampitak W et al: Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. J Arthroplasty. 34(2):295-302, 2019
                                                                              2. Sinha SK et al: Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg. 115(1):202-6, 2012