Postoperative Analgesia Using Peripheral Anesthetic Block of the Foot and Ankle

Stéfani, Kelly Cristina; Ferreira, Gabriel Ferraz; Filho, Miguel Viana Pereira

doi:10.1177/1071100717739670

Cited by 11 publications

(6 citation statements)

References 15 publications

(14 reference statements)

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“…For this study however, different risk factors were selected because national health care and economic unemployment support are guaranteed, so socioeconomic status is not a problem. Consistent with the literature [ 46 ], we did not observe anaesthesia complications, supporting the use of regional anaesthesia, which has several advantages including improved patient satisfaction, faster mobilisation, reduced length of hospital stay and reduced used of opioids [ 41 , 57 ].…”

Section: Discussionsupporting

confidence: 90%

“…The impact of risk factors and the type of anaesthesia ( femoral-sciatic versus ankle block ) on pain, pain during movement, satisfaction and quality of life was also analysed, finding that the block type does not have any influence on clinical outcomes. Many studies have compared ankle blocks to more proximal blocks [ 42 , 44 , 45 ] or compared the analgesic efficacy of an ankle block in addition to general anaesthesia or spinal anaesthesia [ 46 , 47 ]. Only one study, by Tharwa et al, compared the efficacy and safety of ankle block versus sciatic-saphenous nerve block in 42 patients with HV having undergone surgery [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Biz

Iudicibus

Belluzzi

et al. 2021

BMC Musculoskelet Disord

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Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Biz

Iudicibus

Belluzzi

et al. 2021

BMC Musculoskelet Disord

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“…The findings of our multivariable analysis also showed that prescription amount was the only independently significant influencing factor on opioid consumption. Gupta et al, 17 as well Stefani et al, 30 demonstrated the importance of regional anesthesia after foot and ankle surgeries and reported lower pain scores and lower narcotic use for up to 56 days after surgery with an improved pain intensity during the immediate postoperative period. Presumably, patients who received a peripheral block were undergoing more significant surgeries and, therefore, were prescribed more pain medication on the assumption that the procedure would be more painful.…”

Section: Discussionmentioning

confidence: 98%

Opioid Consumption Rate Following Foot and Ankle Surgery

et al. 2019

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Background: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economic, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among all operative specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures and identify risk factors associated with higher use. Methods: A total of 535 patients who underwent foot and/or ankle surgery between August 2016 and March 2018 were included in the study. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the 2-week postoperative visit, the patients self-reported the amount of consumed opioids. Prescription details, number of opioid pills consumed, refill requests, pain-issue-related telephone calls, and additional physician/emergency department visits were documented. Patient demographics, comorbidities, use of regional anesthesia, hospitalization, surgery type/severity, and preoperative opioid use were collected. A total of 244 patients had a sufficiently complete data set for inclusion in the final cohort. Subjects had a mean age of 50 years (±16.3) and a body mass index (BMI) of 29 (±6.1). Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. Results: On average, patients consumed 46.6% of the prescribed pills following a bony procedure and 42.4% after a soft tissue procedure, which resulted in a total of 4496 leftover pills. BMI, procedure type (bony vs soft tissue)/severity, and number of opioids prescribed were positively correlated with elevated consumption rates ( P = .008, P < .001, P < .001, P < .001, respectively). Conclusion: BMI, procedure type, and higher initial pill dispensation correlated with a larger number of consumed pills during the postoperative period. On average, patients took 42.4% of the prescribed opioid after soft tissue procedures and 46.6% after bony procedures, resulting in a significant number of unused pills. Future guidelines are necessary to improve postoperative pain management to prevent narcotic overprescription and minimize the downstream potential for unprescribed community opioid access. Level of Evidence: Level III, retrospective case series, analytic.

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Section: Impact Of Coadministered Therapies On Outcomes Of Spinal Ane...mentioning

confidence: 99%

“…In a prospective, randomized study of 57 patients undergoing foot and ankle surgery with spinal anesthesia with or without ankle block, patients who received an ankle block reported both a lower mean postoperative pain score and a longer onset to pain after surgery. 85 In the context of hip fracture surgery, preoperative femoral nerve block or fascia iliaca compartment block may also aid positioning for the performance of spinal anesthesia. Femoral nerve blockade, performed before spinal anesthesia, in patients undergoing hip fracture surgery can be performed as a single shot block immediately preoperatively or as a continuous catheter technique several hours or even days in advance of surgery.…”

Section: Peripheral Nerve Blockadementioning

confidence: 99%

Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

2023

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Comparative effectiveness research aims to understand the benefits and harms of different treatments to assist patients and clinicians in making better decisions. Within anesthesia practice, comparing outcomes of spinal versus general anesthesia in older adults represents an important focus of comparative effectiveness research. The authors review methodologic issues involved in studying this topic and summarize available evidence from randomized studies in patients undergoing hip fracture surgery, elective knee and hip arthroplasty, and vascular surgery. Across contexts, randomized trials show that spinal and general anesthesia are likely to be equivalent in terms of safety and acceptability for most patients without contraindications. Choices between spinal and general anesthesia represent “preference-sensitive” care in which decisions should be guided by patients’ preferences and values, informed by best available evidence.

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Postoperative Analgesia Using Peripheral Anesthetic Block of the Foot and Ankle

Abstract: Level I, high-quality prospective randomized clinical trial.

Cited by 11 publications

References 15 publications

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Opioid Consumption Rate Following Foot and Ankle Surgery

Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

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