Deep Peroneal Nerve Block

47 Deep Peroneal Nerve Block


The deep peroneal nerve is a small branch of the common peroneal nerve. The deep peroneal nerve innervates the web space between the first and second toes. The nerve crosses over the anterior tibial artery from medial to lateral just proximal to the ankle joint near the surface of the distal tibia. The deep peroneal nerve can appear as a homogeneous hypoechoic structure surrounded by hyperechoic fat without polyfascicular echotexture. The deep peroneal nerve is more difficult to image in the proximal leg.1 This probably relates to the course of the nerve and its division into a large number of motor branches.2


Ultrasound guidance may provide some advantages over landmark-based approaches to deep peroneal nerve block. One study reported the use of ultrasound improved the onset of deep peroneal nerve block at the ankle although the overall quality of this block was no different.3 Another study has reported high success rates with deep peroneal nerve blocks that combine ultrasound with nerve stimulation.4



Suggested Technique


The deep peroneal nerve and anterior tibial artery lie between the surface of the tibia and the extensor hallucis longus muscle. Because of its superficial location and proximity to bone, the anterior tibial artery is easily compressed by the transducer over the dorsum of the foot and ankle. Light touch with the transducer is necessary to image the anterior tibial artery. By sliding the transducer back and forth from proximal to distal, the crossing of the deep peroneal nerve over the anterior tibial artery can be identified. Both in-plane and out-of-plane approaches are useful for this block. In-plane approach from lateral to medial avoids the large tibialis anterior and extensor hallucis longus tendons. Furthermore, the deep peroneal nerve is most likely to lie on the lateral side of the anterior tibial artery.



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Mar 5, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Deep Peroneal Nerve Block

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Deep Peroneal Nerve Block The Essentials
Anatomy The DPN often crosses over the AT.
This crossing point is near where the AT lies on the surface of the tibia.
Positioning Supine
Operator Standing on the side of the patient
Display Across the table