The long thoracic nerve origins from the spinal nerve roots C5, C6 and C7

The upper two roots typically pierce the middle scalene muscle and the lower passes anterior to the muscle

The components of the nerve enter the axilla behind the brachial plexus and descend approximately in the midaxillary line; it runs on the superficial surface of the serratus anterior muscle which it innervates.

Identify the long thoracic nerve and the dorsal scapular nerve inside the middle scalene muscle with electrical nerve stimulation during ultrasound-guided interscalene brachial plexus block to avoid nerve injury

Selective diagnostic blockade of the long thoracic nerve in patients with suspected pain from serratus anterior muscle spasms

You have now completed the e-course about the advanced ultrasound guided peripheral nerve blocks

You have fulfilled the following learning objectives:

– Understanding the anatomy and sonoanatomy of the advanced nerve blocks

– Knowing how to perform each of the advanced nerve blocks

– Knowing about the pitfalls

Now you are ready to join the hands-on training

The saphenous nerve is usually not visible sonographically at the level of the ankle

It can be blocked by infiltrating the subcutaneous tissue around the long saphenous vein anterior to the medial malleolus

The sural nerve can be blocked as part of the ankle block with ultrasound guidance posterior to the lateral malleolus adjacent to the short saphenous vein

For an ankle block, the tibial nerve can be blocked with ultrasound guidance posterior to the medial malleolus, where the target nerve descends together with the posterior tibial artery and vein

Fredrickson MJ: Ultrasound-guided ankle block. Anaesthesia and Intensive Care 37(1): 143-44 (2009)

Lopez AM, Sala-Blanch X, Magaldi M, Poggio D, Asuncion J, Franco CD: Ultrasound-guided ankle block for forefoot surgery: The contribution of the saphenous nerve. Reg Anesth Pain Med 37(5): 554-57 (2012)

Coe A, Ram S: Ultrasound-guided ankle block for forefoot surgery: Is sural nerve block necessary? Reg Anesth Pain Med 38(3): 251 (2013)

The saphenous nerve is the only nerve innervating the ankle and foot that is not a sciatic nerve branch; it is a purely sensory nerve

The saphenous nerve branches off the femoral nerve in the subinguinal region and descends subsartorially first in the femoral triangle and then into the adductor canal, where it pierces the vastoadductor membrane and emerges between the sartorius and gracilis and pierces the deep fascia on the medial side of the knee

A sensory infrapatellar branch supplies sensory branches to the medial part of the knee

The saphenous nerve supplies sensory branches to the medial side of the leg, ankle and foot including the medial part of the capsules of the ankle joint and the subtalar joints

On the medial side of the leg and ankle the saphenous nerve is joined by the long saphenous vein

In front of the ankle joint the deep peroneal nerve runs adjacent to the dorsal pedis artery and vein

The deep peroneal nerve can be blocked with ultrasound guidance 5-10 cm proximal to the ankel, where the target runs adjacent to the anterior tibial artery sandwiched between the muscles of the anterior compartment and the interosseous membrane