Deep Peroneal Nerve Block

One of the five nerves commonly blocked or anesthetized during ankle surgery is the deep peroneal nerve.

 It can be done as a regional block and is a great way to achieve regional anesthesia for surgery in high-risk patients during general anesthesia.




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Anatomy

The anterior leg compartment and the dorsum of the foot are innervated by the deep peroneal nerve. 

It is also in charge of the sensation of the foot's first interdigital cleft, or the space between the first and second digits. 

The nerve is derived from the common peroneal (fibular) nerve, which originates from the dorsal branches of L4, L5, S1, and S2 as part of the sciatic nerve.

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Indications

Among the indications for a deep peroneal nerve block are:

  • Regional anesthesia for the ankle or foot during surgery

  • Anesthesia for foot burns

  • First interdigital clef laceration repair

Deep Peroneal Nerve Block

Contraindications

to Deep Peroneal Nerve Block

  • Allergy to local anesthetics

  • Patients receiving high levels of local anesthetic are at risk of systemic toxicity from local anesthetics (LAST)

  • Cellulitis or an abscess at the injection site

  • Refusal of the patient

  • Patients at risk of compartment syndrome at the injection site

  • Caution is advised in anticoagulated patients, but the procedure can still be performed because the foot and ankle are compressible sites.

References

and Interesting Articles

  • Fletcher T, Orgill BD, Barth B. Deep Peroneal Nerve Block. [Updated 2021 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532887/
  • De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, de Mey J, Scafoglieri A. Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation. Radiographics. 2015 Sep-Oct;35(5):1469-82. doi: 10.1148/rg.2015150028. Epub 2015 Aug 18. PMID: 26284303.
  • Soberón JR Jr, Sisco-Wise LE, Dunbar RM. Compartment syndrome in a patient treated with perineural liposomal bupivacaine (Exparel). J Clin Anesth. 2016 Jun;31:1-4. doi: 10.1016/j.jclinane.2015.11.001. Epub 2016 Mar 16. PMID: 27185666.


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