Lateral Popliteal Blocks For Postoperative Anesthesia

Abstract

We present our technique for providing postsurgical pain control in foot and ankle surgeries performed at our institution. The procedure utilizes a lateral approach to the sciatic nerve through the distal biceps femoris muscle with the patient lying in the supine position. The sciatic nerve is blocked near the bifurcation of the common peroneal and posterior tibial nerves. The saphenous nerve is anesthetized through an auxiliary subcutaneous approach. This technique, although simple to perform, provides excellent postoperative pain control and patient satisfaction for 12 to 26 hours. In addition, the need for intraoperative and postoperative narcotic use is minimized, reducing sedation and nausea while facilitating earlier discharge. Keywords: anesthetic technique, sciatic nerve block, popliteal block, transbiceps femoris approach, pain control n HISTORICAL PERSPECTIVE The desire to improve postoperative pain control and reduce postoperative narcotic medication use following foot and ankle surgery has led to recent increased interest in regional blocks to the sciatic nerve. 1-3 Ankle blocks, which are more commonly used, are an effective means of pain control. However, due to the limited volume of anesthetic that can be injected, their duration is comparatively short. 4 Labat first described blocking the sciatic nerve through the popliteal fossa in 1923. 5 Early descriptions of popliteal nerve blocks required prone positioning of the patient and used a posterior approach. 6 McLeod et al described a new technique of blocking the sciatic nerve in the popliteal fossa using a lateral approach with the patient lying supine in 1994. 7 The lateral approach was quick and easy to perform, provided effective analgesia for an average of 18 hours, and had high patient satisfaction. A subcutaneous block of the saphenous nerve as described by Scott 8 was later added for additional pain control. 4 Slight modifications of McLeod et al's technique including a saphenous nerve block are what we use today.n INDICATIONS AND CONTRAINDICATIONSThe technique described here is used on outpatient surgical patients where postoperative pain control with oral pain medications alone is a concern. We have also found this technique to be an excellent adjunct for pain control in our major inpatient reconstructive cases. Hansen et al have successfully employed a neural blockade of the popliteal fossa as the sole anesthetic for both operative and postoperative pain control in foot and ankle surgery. 2 This technique is preferred over a proximal sciatic nerve block because patients retain hamstring function, allowing them to use crutches when they leave the facility. This regional block has an advantage over an ankle block, as it allows for surgery to be performed proximal to the ankle using a calf tourniquet, as well as having a longer duration of action.A popliteal block is contraindicated in patients who have had recent trauma to the lower extremity or in any patient where development of a compartment syndrome is a concern. It is also contraindic...

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