I too prefer nerve blocks for procedures on the sole, but have not had
the great success you describe. There is considerable overlap of the
posterior tibial and sural nerves, so for many lacerations both need to be
blocked. Waiting is very important and, at least theoretically,
buffering may improve efficacy by increasing the lipid solubility. But
pressure sensation (thicker fibers) often remains and young children
don't much like feeling anything. Does the introduction of foreign
material (sutures) increase or decrease the likelihood of infection?
St. Christopher's Hospital for Children
On Sun, 23 Jul 1995, Garry Wilkes wrote:
> Injections into soles, palms, and digits are:
> .difficult - septate areas with injection being forced and sometimes
> ineffective if only some of the compartments are infiltrated.
> .ineffective for deeper tissue
> Nerve blocks always work provided your knowledge of anatomy is good and you
> are prepared to WAIT. I often catch residents assuming that blocks have not
> worked because sensation is present after a few minutes only.
> For lacs or F.B.s on soles a posterior tibial nerve block provides excellent
> analgesia for skin and deeper tissues - particularly relevant for fishing
> out a F.B. - and topical L.A. can be used at the injection site for children.
> Steri-strips are useful for superficial lacs only as they leave a 'dead
> space' with deeper wounds inviting infection.
> I've never met a child able to keep their feet clean for one day let alone
> long enough for a wound to heal properly. My preference is to suture gapping
> wounds on soles of feet and I use nerve blocks preferentially for both
> paediatric and adult patients.
> Dr Garry Wilkes MBBS FACEM
> Department of Emergency Medicine
> Royal Brisbane Hospital
> Queensland, Australia
> Email [log in to unmask]