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
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
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
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
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
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