Honeychomb

Posterior Tibial Nerve Block | Priyan Wickremesinghe MD & Michael Halperin MD MPH | Bronx, NY

Clip: Anesthetic infiltrating the space posterior (to the left of the yellow line on the screen) to the posterior tibial nerve. To the right of the yellow line is the hyper-echoic honeycomb like posterior tibial nerve.

Clip: Anesthetic infiltrating the space posterior (to the left of the yellow line on the screen) to the posterior tibial nerve. To the right of the yellow line is the hyper-echoic honeycomb like posterior tibial nerve.

Setup for posterior tibial nerve block used to target the wound on the lateral aspect the sole of foot.

Setup for posterior tibial nerve block used to target the wound on the lateral aspect the sole of foot.

A middle aged male sustained two lacerations after kicking his foot through a glass door. The decision was made to use an ultrasound-guided posterior tibial nerve block to anesthetize the wound on the sole of his foot.

POCUS: The clip shows a transverse view of anesthetic infiltrating the space just posterior (towards the achilles tendon) of the posterior tibial nerve. For the setup the linear probe is placed proximal to the medial malleolus.

POCUS pearl: Looking at the screen, on the right of the honeycomb-like hyper-echoic circular posterior tibial nerve is the pulsating tibial artery. Priyan nicely sets up to infiltrate the space posterior to the posterior tibial nerve, away from the vascular bundle.