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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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As mentioned, patients should be adequately sedated during this block because it is primarily a “volume” block. Although the medial and lateral malleoli approaches to an ankle block appear superficially similar, there are differences. The sural nerve (lateral ankle) is found in a more superficial position relative to the malleolus than the tibial nerve (medial ankle). Thus, the anesthesiologist should make sure that the sural portion of the block is performed with this distinction in mind. The block should not be chosen if high tourniquet pressures are required to carry out the surgical procedure. Again, epinephrine-containing solutions should be avoided in circumferential injections of the ankle. After outpatient foot surgery, patients often can walk with assistance even after ankle block has been used. This is sometimes an advantage, as the stay of these patients in the outpatient surgery center generally is not unnecessarily prolonged, and they experience effective postoperative analgesia.

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