Hi,
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I want to learn how to do a post tib nerve block. I tried and was unsuccessful. Does anyone have any good references or personal advice? I'm not certain on angle of insertion or depth of needle. Is this best performed prone or supine?
Thanks
srd
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Look at my facebook site where I answered your question.
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SRD:
I am wondering where you practice and where you were trained.
Did you not learn this in school or in your clinical training?
I'm not being disrespectful, I just think it odd that if you do not have formal training how you can just pick up this skill post degree and then utilize it on patients.
The other question is, did you attempt a posterior nerve block on a patient as your FIRST attempt ever (without supervision?)
Steve -
Post tib blocks are not routinely taught at undergraduate level in the UK. Neither is local infiltration.....:bang:
I sought out a practitioner who was willing to mentor me during my second year summer break. When I included his `signing off` as competent in post tibs for the required log for LA training my tutors were quite suprised!
There is certainly a gap in the market for post grad LA technique training....
cheers,
Bel -
Ian Reilly needs to take the live show on the road kind of like a book tour but different- All things being equal and even though I´m not allowed to use local in Sweden I would make the trip keep the hand in go over a few things.
http://www.amazon.co.uk/Foot-Ankle-Injection-Techniques-Practical/dp/0702031070/ref=sr_1_2?s=books&ie=UTF8&qid=1288691296&sr=1-2 -
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I graduated in 2007. We were informed that we would only ever need to do digital ring blocks and were thus only trained in such. As I said, I took it upon myself to obtain other LA relevant training.
Maybe other universities had a different approach....I do hope so. -
Now that`s what I call music! Go on Ian....you know you want to! -
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Hi Belinda
>>Now that`s what I call music! Go on Ian....you know you want to!
Stuart and I ran a number of these. Ankle block practical was always the best received.
I'm semi-retired these days but Stuart still runs the course. I think his last one was Dec 2009.
ATB
Ian -
Thanks for that Ian, I`ll have a chat with Stuart. He`s just landed a post very near to my practice!
Cheers,
Bel -
Hi Bel' ,
I was at Huddersfield 1995 - 1998.
Jim Pickard was in charge of the local anaesthesia training then. Which included ankle blocks. We practised on each other. :D Only my opinion but I consider this the best way to learn.
Personally I think it is a disgrace if this is no longer the case in UK podiatry schools.
ttfn,
Mand' -
Wocha Mand`
I agree. Unfortunately, students are no longer allowed to (officially) practice on each other...stupid, eh? Still, I just used to practice on myself, still do if I`ve nothing better to do! Keeps me off the streets.
Cheers,
Bel -
I'm just being a pain in the rectum i know, but there is no such thing as the posterior tibial nerve. Artery yes, nerve no.
I always here people call it this and get a little frustrated.
Sorry.
George -
In my world too George ;) -
Whilst we're being pedantic - it should be 'hear' not 'here' in your 2nd paragraph. ;)
Seriously though you're right!
Bob -
Ah yes Bob, your right. I wasn't being pedantic just venting as I hear many people refer to it as this.
George -
Nothing wrong with pedantry. Its just correction with an embarrassed expression on its face.
When I was at school we saw tib blocks, and did the theory, but never practiced them. Like bel, I learned the technique since and found it to be invaluable in everyday practice.
I've seen it done several different ways, all of which work for their proponent so I guess there is always room for learning. Bel and I have a challenge set for the next time we see each other, who can get a block on the other with the least amount of scandonest.
I bid 1-1.5 mls. ;) -
Hmmm....we shall see. We`ll require an adjudicator.:drinks -
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Robert
and as a gentle suggestion, would we prefer to use a larger dose (that would last longer) of a more potent drug (that would last longer) that is les cardio-toxic???
personal thing, but i think there are better drugs than scandonest on the market... and which will reduce the need for post op meds after the LA has worn off.
... and if using scandonest - i'll assume with a dental syringe - how do you aspirate round the posterior compartment???
just a thought!
Ian -
Never had any problems with scandonest, Its always lasted well long enough for me. Why would I want someone numb for longer than necessary? I'm assuming it can't be all that cardiotoxic or it would not be licensed for use. But by all means, what do you prefer?
Re aspiration, I generally use a self aspirating dental syringe, occasionally a standard syringe with a 27 guage needle. Both capable of aspiration. I'm sure not all of those 3 exclamation marks are needed. -
Hi Robert
I'm quite the fan of levobupivacaine and ropivacaine. Very useful in the larger dosages I use...
as I say, just a thought ...
ATB
Ian -
Maybe next time I order a batch of LA I'll give it a punt. Where do you buy it from?
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Hospital pharmacy... its always in the cupboard/theatre!
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Could be a challenge If you don't work in a hospital!!
I get mine from my local Pharmacy. I'm sure they'd track it down for me.
Thanks:drinks -
Cheers
D;) -
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Hi Robert
I had a problem getting levobupivicaine from my local pharmacy. However I managed to get it directly from Abbott Laboratories 01759 580099. It works out about £15 for a box of 10 x 10ml ampuoles. Hope this is of help.
Regards
Michael -
Indeed, for me and any lurkers. Thankyou.
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Hi Ian,
Many thanks,
Mandy. -
I studied at Plymouth University - 1996-1999. As students we performed ankle blocks, dig blocks, infiltration, etc. on each other. Our exams also consisted of performing both an ankle and dig block on a peer.
I recently performed a tibial block in order to treat a rather nasty 15 year old neuro HD. -
D;) -
Mandy
7.5 mg/mL solution - 0.75% - good and strong!
ATB
Ian -
So, 1.1 ml of mepivacaine later......it worked. But only the medial planter nerve went off :rolleyes:
I still paid my £10.00 as it was `a block` of sorts even if it was distal to the bifurcation... -
You fib missy! Since only half the forefoot went off I paid you back a fiver of that if you remember!
But still. 1 ml of LA, I was quite pleased with that. Next time I'll see if I can do the same trick a bit more proximal. -
Where was I fibbin`? It worked as a medial plantar nerve block. A good demo in dermatones anyway.
OK, I appreciated the fiver ;) -
Is there anyone north of the border who would be willing to let me come and observe this? I'd love to add this to my repertoire and QMU only teach digital blocks.
I've just bought Stuart Medcalf's book, but I suspect 1st hand experience may be just slightly better.. but off the watch the DVD so you never know!
Any offers gratefully received!!!
Lucy -
Cheers,
Bel
<
Influence of Smoking on Wound Healing in Patients Undergoing Nail Matrix Phenolization
|
The myth
& death of the hypermobile 1st ray
>
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