Introduction
Ankle block is an extremely useful regional technique for providing analgesia and anesthesia for foot surgery.[1] When compared to other regional anesthetic techniques such as sciatic block or a spinal anesthetic, the ankle block offers several advantages including the preservation of motor function, the ability to ambulate and a low risk of serious complications.[2,3] It is of particular use in patients who may be at higher risk of complication from a general anesthetic, and in whom performing a spinal anesthetic may be technically challenging[4] or relatively contraindicated. The application of ultrasound guidance has eliminated the traditional limitations of the ankle block such as procedural pain and variable block success. In this article, we review the practical aspects surrounding the use of ultrasound guided ankle block and conclude by outlining the technical aspects of performing it.
Limitations of ‘Landmark guided ankle block’
While the ‘Landmark guided ankle block’ approach has been in use for a long time, it has several disadvantages which contribute to suboptimal success rates. In a randomized controlled trial of landmark guided ankle block versus proximal sciatic block, McLeod et al found up to 16% of patients who received LGAB required rescue morphine in the post-operative recovery
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Alternatively, rolled up blankets or pillows may be used to elevate the leg if a bolster is not available. To access the nerves on the medial aspect of the ankle (the tibial nerve and the saphenous nerve), the leg is flexed at the knee and externally rotated at the hip. For the deep peroneal nerve, the leg is placed in a neutral position, while for the nerves on the lateral aspect of the ankle (i.e. the superficial peroneal nerve and the sural nerve), the knee is flexed and the hip internally
The first activity was isolating the gastrocnemius muscle. A cut between the thigh and hip was made so the skin can be pulled down past the lower leg. Then the tendon was cut away from the bone of the heel and one end of the nine-inch string was tied to the tendon. This led to the isolation of the sciatic nerve, found between the hamstring and heel on the lateral side of the thigh. Using fingers, the seams along the quadriceps and hamstring underwent a blunt dissection. In doing so, the glass-dissecting probe was used to free the sciatic nerve embedded in the tissues. A four-inch string was inserted between the nerve and the tissues. Then the transducer was calibrated using a fifty-gram block under the “Frog Muscle” program. Parameter of CAL 1 was changed to zero grams and CAL 2 was changed
Murray H, Husk L. (2001) Effect of kinesio taping on proprioception in the ankle. J Orthop Sports Phys Ther 31; A-37.
Vannie, S. M. D., Braz, J. R. C., Modolo, N. S. P., Amorium, R. B., & Rodrigues, G. R. (2003, March). Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Journal of Clinical Anesthesia, 15, 119-125.
Winfield, H., Katsikitis, M., Hart, L. and Rounsefell, B. (1989). Postoperative pain experiences: Relevant patient and staff attitudes. [online] 34(5): pp.543-552. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-45WYV7R-7G&_user=10&_coverDate=12%2F31%2F1990&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=35e6b5e8c8f803b487b35d4ae3b06cef&searchtype=a[ [accessed 8/5/2013]
Peripheral neuropathy is a serious condition that can be fixed in multiple ways. If an individual is having trouble and experiencing more than one of the symptoms such as pain or muscle weakness, he or she should make a visit to see their doctor and discuss the possible reasoning behind it. A doctor knows best and can prescribe the necessary medications or treatments to help the patient feel better and hopefully stop the patient from having paralysis. There are ways to prevent this condition and they should be taken into consideration.
Institute of Medicine Report from the Committee on Advancing Pain Research, Care and Education. (2011). Relieving Pain in America A Blueprint for Transforming Prevention, Care, Education and Research. Retrieved from http://books.nap.edu/openbook.php?records_13172
The purpose of this paper is to present a discussion of the application and evaluation of Post-Operative pain management in elderly patients with dementia in a rehabilitation setting.
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
The soleus, gastrocnemius and tibialis anterior contract isometrically to keep the ankle stable at 90 degrees (Teachpe.com n.d.) (The previous reference identified was used to identify key joint types and muscles throughout my analysis).
Lindley, P., Pestano, C. R., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: Nursing perspective. Journal of Advanced Nursing, 65(7), 1370-1380. doi: 10.1111/j.1365-2648.2009.04991.x
In each zone, impulses and reflexes travel until they reach nerve endings in the feet and the hands. These zones are believed to be meridians along which energy flows. Placing pressure on the nerve endings in the hands and the feet will affect the organs found in that particular zone (http://www.reflexology.org/aor/refinfo/healart.htm). As well as longitudinal zones throughout the body, there are also cross-reflex points. These cross-reflex points are corresponding points on the opposite side of the body which can be useful in administering reflexology treatment when pressure is not able to be placed on the reflex point....
Studies have shown taping an ankle can limit range of motion if done correctly.1, 5 Another study done by Reut...
...amount of pain) is a great teaching tool for the patient who is able to self-report (Nevius & D’Arcy, 2008). This will put the patient and nurse on the same level of understanding regarding the patient’s pain. The patient should also be aware of the added information included with the pain scale: quality, duration, and location of the pain. During patient teaching, it should be noted that obtaining a zero out of ten on the pain scale is not always attainable after a painful procedure. A realistic pain management goal can be set by the patient for his pain level each day.
Patients feel fear not so much from the actual pain but from the lack of control that they feel lying in a dental chair. That creates a lot of anxiousness in some patients, as they don’t feel helpless. Most dentists continue treating all patients in a similarly assuming that they all have similar pain level and will handle the procedure in the same way. Dentists should be mindful of their patient’s level of tolerance and make them aware of the entire procedure ahead of time so that they are able to handle the unexpected situations. They should take time to ensure that the patient feels comfortable at every step. Use of medications and wide array of techniques can help patients eliminate pain and anxiety and making dental visits a pleasant experi...
This reaction is a reflex - it was not a direct command. However, if a person’s reflex pathway was or is disrupted in some way, he or she might not be able to transmit the information to his or her brain fast enough to avoid getting burned, or they might not even be able to sense the heat until it is too late. Also, there are several reflex reactions that respond to instability, such as the knee jerk. The knee jerk is a sudden kicking movement made when something or someone roughly taps on the patellar tendon, which is located right below the kneecap. The tap causes a slight stretch in the quadriceps, which is the front of the upper leg. This causes the muscles to contract in reaction, and therefore straighten the leg through a kicking motion. Absence of the reaction indicates that the central nervous system may be damaged. Doctors also use the knee jerk reflex to help in recognizing thyroid disease. The knee jerk, also known as the patellar reflex, is one of the many forms of a spinal reflex. A spinal reflex is sought to be important due to its automatic responses to stimuli that require no thinking activity and is a form of protecting