Advances in Popliteal, Adductor Canal, and Ankle Blocks
- Valkyrie Blog Team
- 5 days ago
- 3 min read
As we wrap up 2025, we turn our attention to three lower extremity nerve blocks that have undergone meaningful refinement this year: the popliteal sciatic block, the adductor canal block, and the ankle block. Each has benefited from enhanced ultrasound guidance and technique optimization, reflecting a broader shift toward precision, patient comfort, and improved perioperative pain management.
Popliteal Sciatic Nerve Block – The Crosswise Approach
Traditionally performed with patients in the prone or lateral position, the popliteal sciatic block has been invaluable for ankle fractures, Achilles tendon injuries, and posterior calf trauma. Yet repositioning patients in acute pain can be nearly impossible.
Innovation: The crosswise approach (CAPS) allows the block to be performed with patients supine, using ultrasound guidance and an in-plane needle trajectory through the biceps femoris.
Clinical impact: Case reports demonstrated dramatic pain relief, reduced opioid reliance, and successful procedures without sedation—even in patients unable to tolerate repositioning.
Bottom line: CAPS expands the accessibility of the popliteal block in emergency settings, aligning with patient comfort and workflow efficiency.
Adductor Canal Block – Finding the Optimal Volume
The adductor canal block (ACB) has become a cornerstone of multimodal analgesia in total knee arthroplasty (TKA), prized for sparing quadriceps strength while controlling pain. Until recently, the ideal volume of local anesthetic was unclear.
Study insight: A prospective trial compared 20 ml, 30 ml, and 40 ml volumes.
Findings:
20 ml: insufficient analgesia, higher opioid use.
40 ml: strong analgesia but significant motor block in the first 8 hours.
30 ml: the sweet spot—effective pain relief with preserved motor function.
Bottom line: For TKA, 30 ml ACB offers the best balance between analgesia and mobility, supporting early ambulation and opioid-sparing recovery.
Ankle Block – Ultrasound-Guided Precision
The ankle block targets five terminal nerves (posterior tibial, deep peroneal, superficial peroneal, sural, and saphenous) and is a mainstay for foot and ankle surgery. Historically, landmark-based techniques were variable in success.
Advancement: Ultrasound guidance allows direct visualization of nerves, reducing needle passes and improving accuracy.
Outcomes: Nguyen et al. reported higher success rates, fewer conversions to general anesthesia, enhanced patient comfort, and no major complications.
Bottom line: Ultrasound-guided ankle block transforms a sometimes unreliable technique into a consistent, patient-centered option for podiatric and orthopedic procedures.
Final Reflections
Across these three blocks, the themes are clear: ultrasound guidance, patient comfort, and evidence-based refinement. The crosswise popliteal approach improves emergency care, the 30 ml adductor canal block optimizes TKA recovery, and ultrasound-guided ankle block elevates reliability in foot surgery.
As we close 2025, these innovations remind us that regional anesthesia is not static, it is a dynamic field continually adapting to patient needs and clinical realities. Looking ahead, the integration of these techniques into training and practice will further advance perioperative care, reduce opioid reliance, and empower clinicians worldwide.
Valkyrie’s continuous improvement program systematically reviews procedural updates and clinical advances to ensure that each training product incorporates the most current techniques as reflected in our Popliteal, Adductor Canal, and Ankle Block Simulators.
References:
Brown JR, et al. Crosswise approach to the popliteal sciatic nerve block. JEM Reports. 2024;3(1):100072.
Ekinci M, et al. Effects of ultrasound-guided adductor canal block at different volumes on postoperative analgesia management in patients undergoing total knee arthroplasty. BMC Anesthesiology. 2025;25:510.
Nguyen L, et al. Ultrasound-guided ankle block: technique and outcomes. J Foot Ankle Surg. 2025;64(1):22–29.
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