Source: De Mey et al, Reg Anes Pain Med 2001; 26(6): 504-6

Reviewer:  R. Prasad, MD

Summary:

• 5 cadaver legs dissected at tibial tuberosity: saph n just medial (within 1cm) and posterior to saph v
• 20 volunteers blocked bilaterally with 5ml 2% mepiv, randomly assigned:
• subcut one side: btwn tibial tuberosity and medial head of gastrocnemius m, at least 1cm over border with muscle
• paravenous other side: tourniquet placed, let hanging >= 60sec, then local fanned near vein
• After 15min, success rate 20/20 (100%) paravenous vs. 6/20 (33%) subcutaneous

• This would be great! I've never been happy with my success with this block.
• However, the few times I've looked recently, I'm not sure that I've been "easily" able to identify the vein.
• The way I learned the block, the subcut infiltration is on the medial tibia, from skin over gastroc to edge of patellar tendon (wheal will probably overlie saph n and v). Their subcut infiltration, as shown in figures, does not appear to extend far enough medially, so 33% may be artificially low.