Clinical Practice and Cases in Emergency Medicine

Introduction: Frostbite is a painful condition that requires rapid identification and wound care to optimize outcomes. The Posterior Tibial Nerve (PTN) block, however, has yet to be described in the literature for pain control of frostbite injuries on the plantar surfaces.

Case Series: In this case series we discuss three patients who presented with bilateral frostbite on the plantar surfaces. Ultrasound-guided PTN blocks were performed on these patients and pain control was achieved in under 10 minutes, facilitating burn care. No patient experienced adverse effects. All patients had been scheduled for future debridement that was either not performed or performed using intravenous (IV) medications due to pain control issues.

Conclusion: The ultrasound-guided PTN block facilitated proper wound debridement that was previously intolerable with oral and IV pain medications. This case series highlights the efficacy, safety, and accessibility of this block for frostbite pain control in the emergency department.   Additionally, it emphasizes the potential role of ultrasound-guided PTN blocks as part of a multi-modal pain control strategy in other clinical settings.