A numb foot that will not lift the day after a popliteal block
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Mr. Jamal Reed is a 46-year-old delivery driver, 98 kg, with well-controlled type 2 diabetes and no known neuropathy; his preoperative note records normal sensation and strength in both feet. Yesterday at 8 a.m. he had open fixation of a right ankle fracture under general anesthesia, with ultrasound-guided popliteal sciatic and saphenous blocks using 0.5% ropivacaine. The blocks were placed while he was awake and comfortable, with no pain or paresthesia recorded on injection. A thigh tourniquet was inflated for 105 minutes, and his leg is in a posterior splint.
It is now 10 a.m. His nurse calls you because his foot is still numb and he cannot lift his toes. The facilitator will give examination findings when you examine him.
Your task: evaluate Mr. Reed and discuss your findings and plan with him.