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Ankle Block

Discussion in 'Podiatry Trivia' started by RobinP, Nov 30, 2011.

  1. RobinP

    RobinP Well-Known Member


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    Not being a podiatrist, I watched this with growing horror. Principally because I had volunteered to let our podiatrist do a practice tibial nerve block on me.

    Is this normal? Not so much the first bit, but a bit later, it looks gratuitously rough.

    Horrified (and not volunteering any more if this is the norm - yes I know this is an ankle block and not a tibial block) of Isle of Man

     
    Last edited by a moderator: Sep 22, 2016
  2. blinda

    blinda MVP

    Oops!
     
    Last edited by a moderator: Sep 22, 2016
  3. twirly

    twirly Well-Known Member

    Hi Robin,

    I would suggest this 'Doctor' has only previously performed an ankle block on a cadaver! Quite the most unecessarily brutal performances of an ankle block I have ever witnessed.

    I wouldn't let this fella within 200 yards of one of my patients. Only my opinion you understand. :mad:

    Grateful I wasn't trained in this way or I may have reconsidered my future.

    Kindest regards,

    Mandy.

    PS. Intersted to know how many ml of Local he injected overall given it looked like an awful lot used to block the Tibial nerve alone. :rolleyes:
     
    Last edited by a moderator: Sep 22, 2016
  4. blinda

    blinda MVP

    Actually, there`s usually a lot more blood when I do it.....

    Seriously, this is nothing like how I perform a tib block, otherwise I wouldn`t offer my ankle up so willingly. You`re more than welcome to accompany Sarah when she comes to shadow and practice on me?
     
  5. Disgruntled pod

    Disgruntled pod Active Member

    I am speechless!!!! When I did a tibial block on a patient 4 weeks ago, it was NOT like the one in the video!
     
  6. W J Liggins

    W J Liggins Well-Known Member

    I find it very interesting that the good doctor allowed the video to be shown at all. In my view, it is excellent training in how not to carry out an ankle block. Actually, it's not an ankle block at all but a kind of aggregation of a number of blocks (Mayo amongst them) and infiltrations. In fairness, he does seem to aspirate (when the needle is not sticking out of the skin) but the volume of L.A. is huge - even if he is using 0.5% lignocaine.

    Are you sure that this isn't a 'how not to do it' example? I'm sure that the patient believes that it is!

    All the best

    Bill Liggins
     
  7. neilmalc

    neilmalc Member

    Are you sure that's not a scene from a horror movie!!!!!

    Cheers,


    Neil.:wacko:
     
  8. Orthican

    Orthican Active Member

    Like driving by the bad car wreck....you are drawn to look but you really don't like what you see. I would only hope Robin, that your friend does not do it that way!!...yikes!!
     
  9. Paul Bowles

    Paul Bowles Well-Known Member

    Thats actually pretty standard stuff. The patient is obviously sedated. I dont know if it was a full ankle - did he do the sural ? He was pretty darn quick, maybe I missed it. My only query was the amount of local infiltrated, looked like more than 30mls. Probably a combination of lignocaine and bupivicaine though to use that much.
     
  10. ****ing hell!!

    Thats just...

    ****ing hell!!

    Its a sort of cross between the adrenalin scene from pulp fiction and the shower scene fro psycho!!

    I'm not squeamish with needles. Much. Any more. But I will admit that made me feel more than a bit queasy!
     
  11. Peter

    Peter Well-Known Member

    Words fail me..............



    oh no, found a couple

    Holy $h1T!
     
  12. LondonPod

    LondonPod Active Member

    Oh. Sweet. Jesus.
     
  13. Catfoot

    Catfoot Well-Known Member

    It makes me feel sick, and it takes a lot to make me gag .................:eek:
     
  14. blinda

    blinda MVP

    Another contender.....:drinks
     
  15. G Flanagan

    G Flanagan Active Member

    Green needle, nice :wacko:

    It reminds me of that thread a while back about the Gp in Canada? with a new take on nail surgery (i can't find the thread)

    I'm unsure why he does an ankle block and then goes on to do a crap mayo.

    Anyway its okay the patient will be under light conscious sedation by that point (hence the moving) so won't remember a thing (is the motto which i'm sure will banded around that theatre)

    Gosh its a good job those "real doctors" know what there doing :butcher:

    George
     
  16. Griff

    Griff Moderator

    The thing that concerns me is that this patient only came in for her 6/12 nail cut....
     
  17. Paul Bowles

    Paul Bowles Well-Known Member

    Seems like the majority of the UK pods in this thread feel squeemish. Wonder what that says?

    ;)
     
  18. twirly

    twirly Well-Known Member

    If it's foot related....

    http://www.youtube.com/watch?v=SaV-6qerkqI

    Specialise from the top of the head to the tip of the toe (in my opinion) you get more expertise when you employ someone specialised in a specific anatomical area.....rather than a jack of all trades...

    If I was to choose I know which speciality would be my choice. :rolleyes:

    If the guy or gal put my foot in a sling pre op I would run unless I was expecting a baby!!!
     
    Last edited: Dec 1, 2011
  19. G Flanagan

    G Flanagan Active Member

    We all know what an ankle block should look like? :boxing:

    George
     
  20. I have done surgery with orthopedic surgeons for the past quarter century and the ankle block technique demonstrated in this video is not too different from what is done by many orthopedic surgeons.

    Fortunately, during my surgery residency at the VA Hospital in Palo Alto, I was trained using the ankle block technique as taught by Drs. John Ruch and Dalton McGlamry where we were taught to palpate the nerves of the ankle before injecting the local anesthetic. We routinely gave complete ankle blocks using only 3.0 - 5.0 cc of Lidocaine or Marcaine using this technique during my surgery residency in 1983-84. Knowing exactly where the nerves of the ankle are located before the local is infiltrated into the foot/ankle makes all the difference.

    I have included a handout that I made in 1984 once I had returned back to CCPM to do my Biomechanics Fellowship. I gave lectures on this technique to the surgery residents and students on proper ankle block technique using this handout in 1984-1985 during my Biomechanics Fellowship.
     

    Attached Files:

  21. Does that include the bit at 53 seconds where they go straight through the dorsum of the foot and squirt LA across the room at the person walking past? ;)

    I think I'll Stick to the technique in the picture (useful pic, thanks Kevin). 0.5 - 3ccs deposited directly onto the nerve using a 30 guage needle (I can't get hold of 30 guage one inch needles but 27 serves fairly well), sounds a lot more humane than having what looks a lot like a wild ass guess followed by flooding the area with about a gallon on LA!
     
  22. Ok. Drumroll please.

    If you play it in high def, and zoom in, you can see the syringe is a 3/4 oz.

    [​IMG]

    I had to look it up (found it on a veterinary supplies website). 3/4 oz is 22.5mls.

    I don't really want to watch it through again, but he uncorks 3 different syringes.

    Putting the total volume in the region of 60mls.

    Seems a touch excessive to me!!!
     
  23. I therefore award this video the Overly Dramatic Lemur award.

    [​IMG]

    Yes. I'm bored.
     
  24. RobinP

    RobinP Well-Known Member

    It was Sarah that showed me the clip. I know it will be nothing like this. I posted that in jest only. I have no problem with her practicing on me.

    I wouldn't be visiting that particular doctor for an ankle block however!

    I've seen vets doing the same thing to cows and I thought that was pretty unneccessary then.

    I suppose if there was a patient that one didn't want to perform nail surgery on(you know the kind) one could show them this video?

    Robin
     
  25. podiatry.on.line

    podiatry.on.line Welcome New Poster

    Having recently returned from the Society of Chiropodists & Podiatrists annual conference, one of the most refreshing of the lectures was the one entitled "Local Anaesthetic Block" which was followed a few days later by a workshop demonstrating the ankle nerve blocks and popliteal nerve block. The skill demonstrated by the lecturers Stephen M Hewitt, specialist registrar Podiatric Surgeon and Ryan McCallum, Podiatric Surgeon seem to be rather more refined than that which was demonstrated in the video. I know who I would rather refer patients to.
     
  26. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    A current book on anesthesia of the foot necessary:
    Anestesia del pie. Puntos diana.
    Nieto, Eduardo and Rodriguez, Alfonso
    ISBN: 978-84-7429-533-7
    Editorial Glosa S.L. - 2011

    Best regards:
    Jose Antonio Teatino
    Professor of Surgery
    The Academy of Ambulatory Foot & Ankle Surgery
     
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