Sural Nerve Block

The sural nerve block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia for foot and ankle surgery. Peripheral nerve blockade of the sural nerve is relatively straightforward due to the sural nerve's superficial course near the ankle. The technique was first described by McCutcheon in 1965, who reported a 10% failure rate.

Ultrasound-guided sural nerve blockade is a more advanced technique. However, the sural nerve is small and often not visualized. Perivascular approaches may enhance the likelihood of a successful block.

A traditional ankle block consists of peripheral nerve blocks to 4 major nerves of the ankle—the superficial peroneal, deep peroneal, saphenous, and tibial nerves. The inclusion of the sural nerve block depends on the surgical exposure. However, the provider should include the sural nerve block regardless of the operative location within the foot, as deep sensory nerve block of the lateral foot and ankle (e.g., vibration sensation) is often important for patient comfort.