Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants

María Benimeli-Fenollar, José M. Montiel-Company, José M. Almerich-Silla, Rosa Cibrián and Cecili Macián-Romero
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María Benimeli-Fenollar: Department of Nursing, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain
José M. Montiel-Company: Department of Stomatology, University of Valencia, c/Gascó Oliag, 1, 46010 Valencia, Spain
José M. Almerich-Silla: Department of Stomatology, University of Valencia, c/Gascó Oliag, 1, 46010 Valencia, Spain
Rosa Cibrián: Department of Physiology, University of Valencia, c/Blasco Ibánez, 15, 46010 Valencia, Spain
Cecili Macián-Romero: Department of Nursing, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain

IJERPH, 2020, vol. 17, issue 11, 1-12

Abstract: Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time ( p = 0.287), percentage of effective nerve blocks ( p = 0.634), anesthetic block duration ( p = 0.895), or pain level during puncture ( p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals.

Keywords: tibial nerve; supramalleolar approach; retromalleolar approach; injection site coordinates; success rate; regional anesthesia; ankle block (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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