Neuropathic Symptoms following Continuous Popliteal Block After Foot and Ankle Surgery

Abstract

The incidence of neuropathic symptoms may be much higher than previously reported. Smoking may be a risk factor for the development of neuropathic symptoms.

Reply

“…These studies provided additional support for our paper indicating that popliteal block nerve injuries, even though most resolve over time or are mild, could be underrecognized clinically and in an electromyography laboratory. 3,4 Although we agree that temporal association between nerve block and nerve injury alone is not sufficient evidence to assign definitive etiology or causation, the combination of temporal association and anatomical localization strongly suggests this possibility. At the same time, as stated in our report, we cannot exclude the possibility that other factors (such as a postsurgical inflammatory neuropathy or other etiologies) played roles in these cases.…”

“…performed a large retrospective study showing a higher complication rate (5%) than expected, and our report included their observation that this incidence decreased over time, with 0.7% affected at last follow‐up. We also referenced Gartke et al ., who performed a prospective study that noted a surprisingly high incidence of neuropathic symptoms following sciatic block (24% persisting at 8 months after the injury). These studies provided additional support for our paper indicating that popliteal block nerve injuries, even though most resolve over time or are mild, could be underrecognized clinically and in an electromyography laboratory …”

Sciatic neuropathy due to popliteal fossa nerve block

“…The largest studies of PNB demonstrated low rates of neuropathic complications, but more recent studies suggest the incidence might be higher . One report demonstrated a significant number of patients reporting some degree of residual neuropathic symptoms following foot and ankle surgery with PNB at 8 months out from injury …”

“…The reported incidence of sciatic neuropathies after popliteal fossa nerve blocks (PNBs) is variable; no significant neuropathy in 2 large reviews, but a more recent large review demonstrated an incidence as high as 5%, although only 0.7% remained with sequelae at 12 months . In addition, another recent report noted a higher than expected number of patients with residual neuropathic symptoms (24% at 8 months) after PNB . We identified a case of sciatic neuropathy related to popliteal block in our electromyography (EMG) lab.…”

Safety and effectiveness of bilateral continuous sciatic nerve block for bilateral orthopaedic foot surgery

“…The reported incidences of neurological complications in studies specifically involving the sciatic nerve are very low, with no recorded permanent injury. 10,17 Gartke et al 18 found a prevalence of 41% at 2 weeks, decreasing to 24% at 34 weeks in a prospective cohort study of 147 patients receiving a continuous popliteal block for foot and ankle surgery. However, this study has many drawbacks, such as the use of epinephrine added to the initial 40-ml ropivacaine 0.5% bolus, the varying technique for block performance without details about the correct use of ultrasound or nerve stimulation, and the Bilateral continuous regional anaesthesia for foot surgery 623 Copyright © European Society of Anaesthesiology.…”