Place the patient supine

Place the high-frequency linear probe in the axial plane in the corner between the clavicle and coracoid process

Visualize the long thoracic nerve where it runs across the anterior serratus muscle (see second next page)

Insert the needle with in-plane technique from the medial end of the probe and advance the needle until the needle tip is in contact with the target nerve

Inject 5 mL of local anaesthetic until complete perineural spread is obtained

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

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

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

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

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 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

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

The superficial peroneal nerve is most suitably visualized and blocked approx. 10 cm proximal to the lateral malleolus where the target nerve emerges between the anterior and lateral compartments

All five nerves innervating the ankle are blocked in the ankle block. Place the patient supine.

Use a high-frequency linear probe and scan all five nerves in short-axis view:
– The deep peroneal nerve is blocked anterior to the ankle joint where it is adjacent to the dorsal pedis artery
– The superficial peroneal nerve is blocked approx. 10 cm proximal to the lateral malleolus where it emerges between the lateral and anterior compartments
– The tibial nerve is blocked posterior to the medial malleolus where it is adjacent to the posterior tibial artery
-The sural nerve is blocked posterior to the lateral malleolus where it is adjacent to the short saphenous vein
-The saphenous nerve is blocked anterior to the medial malleolus by infiltrating the subcutaneous tissue around the long saphenous vein

The target nerve and proxy arteries are visualized (see next pages). The needle is inserted with in-plane technique. Approx. 3-4 mL are injected perineurally around each target nerve