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The deep peroneal nerve is one of 5 nerves that are often blocked or anesthetized to perform foot or ankle surgery. It can be performed as a regional block and is a great alternative to achieve regional anesthesia for surgery in patients at high risk during general anesthesia. It has minimal risks, reduces complications of wound healing when compared to infiltration anesthesia, and provides better postoperative comfort for the patient. This activity describes the technique of a deep peroneal block, its indications, contraindications, and potential complications. This activity reviews the deep peroneal nerve block and highlights the role of the interprofessional team in safely performing this procedure. Objectives: Identify the anatomy of the deep peroneal nerve. Describe the technique of a deep peroneal block. Review the complications of a deep peroneal block. Summarize the deep peroneal nerve block and the role of the interprofessional team in safely performing this procedure. Access free multiple choice questions on this topic.

The deep peroneal nerve is one of 5 nerves that are often blocked or anesthetized to perform foot or ankle surgery. It can be performed as a regional block and is a great alternative to achieve regional anesthesia for surgery in patients at high risk during general anesthesia. It has minimal risks, reduces complications of wound healing when compared to infiltration anesthesia, and provides better postoperative comfort for the patient.[1] With the rise of ultrasound-guided nerve blockade, there have been reports of longer-lasting and more effective anesthesia.[2] The deep peroneal nerve can also be blocked at the region of innervation for painful injuries such as burns or lacerations. Utilizing this safe and effective technique will aid with analgesia and minimize discomfort while repairing and managing the injury.

Complications include: Bleeding Infection Local anesthetic systemic toxicity (LAST syndrome) Allergic reaction to the local anesthetic Vascular puncture Intramuscular hematoma Intravascular injection Nerve damage[13]

A majority of the time the deep peroneal nerve block is used when performing ankle or foot surgery. As with any surgery, the process is a well-coordinated effort of an interprofessional healthcare team, in this case specifically the surgeon, anesthesiologist, and nursing staff. For these surgeries, either the surgeon or anesthesiologist places the block and nursing is available with medication for an adverse reaction. In a large randomized trial, they found with well-organized care between specialties that there was a low risk of neurologic or nerve block site complications for post-operative complications.[16] (Level 1) It is also important to work closely with pharmacy and nursing during these situations to monitor for local anesthetic systemic toxicity or LAST syndrome. With pharmacy and nursing, they have access and could administer intralipid 20% (1.5 mL/kg bolus, 0.25mg/kg per hour drip) in the case of cardiac arrest due to LAST. These procedures require cohesive team approaches and all members of the interprofessional team are integral to a successful procedure. [Level 5]