What are the clinical considerations prior to administration of a posterior tibial nerve block?

Updated: Jun 14, 2018
  • Author: Heather Tassone, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Equipment preparation and proper patient positioning may make the difference between success and failure.

Consider a hematoma block or bier block when a fracture exists or when more extensive manipulation of the foot is expected to attain more effective analgesia. [14]

Adding a buffering solution, like sodium bicarbonate, can significantly decrease the pain of the injection when performing a nerve block. [9, 10] Add 1 mL of sodium bicarbonate (44 mEq/50 mL) to 9 mL of lidocaine.

Warming the anesthetic solution to body temperature can significantly decrease the pain of the injection. [10]

When unassisted, tape a bottle of lidocaine upside down to the wall prior to the procedure. If more anesthetic is needed during the procedure, it can be obtained from this bottle without compromising the sterility of gloves and equipment.

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