Role of Regional Anesthesia in Foot and Ankle Surgery

Vadivelu, Nalini; Kai, Alice M.; Maslin, Benjamin; Kodumudi, Vijay; Antony, Sible; Blume, Peter

doi:10.1177/1938640015569769

Cited by 23 publications

(14 citation statements)

References 52 publications

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“…Ankle joint arthrodesis was the most painful surgery in our analysis, and RA improved the combined PROs of pain (although still not to a satisfactory level), pain-related interference with mobilization and nausea more than in any other surgical category. These findings support recommendations to increase RA use in this type of surgery [15,16].…”

Section: Discussionsupporting

confidence: 82%

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

Komann

Avian

Dreiling

et al. 2021

JCM

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(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest benefit. (2) Methods: On the basis of 23,911 data sets from 179 German and Austrian hospitals, we analyzed the association of perioperative RA with patient-reported pain intensity, functional impairment of movement, nausea and opioid use for different surgeries. Regression analyses adjusted for age, sex and preoperative pain were performed for each surgery and the following groups: patients receiving continuous RA (surgery and ward; RA++), RA for surgery only (RA+−) and patients receiving no RA (RA−−). (3) Results: Lower pain scores in the RA++ compared to the RA−− group were observed in 13 out of 22 surgeries. There was no surgery where pain scores for RA++ were higher than for RA−−. If maximal pain, function and side effects were combined, the largest benefit of continuous RA (RA++) was observed in laparoscopic colon and sigmoid surgery, ankle joint arthrodesis, revision (but not primary) surgery of hip replacement, open nephrectomy and shoulder surgery. The benefit of RA+− was lower than that of RA++. (4) Discussion: The additional benefit of RA for the mentioned surgeries is larger than in many other surgeries in clinical routine. The decision to use RA in a given surgery should be based on the expected pain intensity without RA and its additional benefits.

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Section: Discussionsupporting

confidence: 82%

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

Komann

Avian

Dreiling

et al. 2021

JCM

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“…However, no serious complication was seen in our patients. Likewise, previous studies used similar doses and found no systemic adverse effects ( 4 , 8 , 13 , 14 ). However, further studies are needed to determine the appropriate dose of local anesthetics for tourniquet pain tolerance.…”

Section: Discussionsupporting

confidence: 62%

“…The sciatic nerve block in the popliteal fossa can be used as a sole anesthetic method for foot or ankle procedures when a thigh tourniquet is not placed ( 3 ). It has been suggested that if needed, adding the femoral block to the popliteal block is effective in tolerating the thigh pain ( 4 , 5 ). However, the femoral block is insufficient to attenuate thigh pain ( 6 ), probably because it only anesthetizes the anteromedial surface of the thigh.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Combined Femoral and Lateral Femoral Cutaneous Nerve Block Plus Popliteal Block with Spinal Anesthesia for Thigh Tourniquet Pain During Foot or Ankle Surgery: A Randomized Clinical Trial

et al. 2020

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Background: A pneumatic thigh tourniquet is routinely used during lower-extremity orthopedic surgeries to provide a bloodless field. When using peripheral nerve blocks, tourniquet-related thigh pain and discomfort limit their routine use as an anesthetic method. Objectives: The aim of the present prospective, randomized study was to compare the efficacy of combined femoral nerve/lateral femoral cutaneous nerve block technique and spinal anesthesia on intraoperative thigh tourniquet pain. Methods: We studied 60 American Society of Anesthesiologists physical status I-II patients scheduled for orthopedic surgery on the foot or ankle using a pneumatic thigh tourniquet. They were randomly divided into two equal groups. The peripheral nerve block group received a combined popliteal, femoral, and lateral femoral cutaneous nerve block under ultrasound-guidance. In both groups, the level of sensory blockade was determined by the pinprick test. The block performance time, anesthetic effect time, intraoperative tourniquet pain scores, the amount of fentanyl and ketamine, surgery duration, and patient’s satisfaction were recorded. Results: The patients’ characteristics were comparable in the two groups. The mean duration of block performance and anesthetic effect, intraoperative tourniquet pain scores, and the amount of intravenous analgesics in the peripheral nerve block group were significantly greater than those in the spinal anesthesia group. Patient satisfaction was similar in both groups. Conclusions: Spinal anesthesia is significantly more effective than the peripheral nerve block method in reducing thigh tourniquet pain. A combined femoral and lateral femoral cutaneous nerve block with popliteal block can improve thigh tourniquet tolerance if supplemented with intravenous analgesics.

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“…Usually, below knee amputations are done with nerve blocks; however, if the incision extends above the knee, patients tend to complain of pain as blocks may be insufficient. [1] In our case, we administered combined lower limb blocks alone to manage a case of cellulitis with thrombocytopenia for above knee amputation.…”

Section: Introductionmentioning

confidence: 99%

Successful management of above knee amputation with combined and modified nerve blocks

2017

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We report a successful management of a case of methicillin-resistant Staphylococcus aureus positive right lower limb cellulitis for above knee amputation under combined nerve blocks. The ongoing sepsis, thrombocytopenia, and severe respiratory infection with wheeze made us avoid both neuraxial block and general anesthesia and plan for a nerve block. We instituted a modified high inguinal femoral block along with sciatic and lateral femoral nerve blocks separately to successfully conduct the case. We decided to report as there were not as many cases as ours in the literature.

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Role of Regional Anesthesia in Foot and Ankle Surgery

Abstract: Therapeutic, Level II.

Cited by 23 publications

References 52 publications

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

Comparison of the Combined Femoral and Lateral Femoral Cutaneous Nerve Block Plus Popliteal Block with Spinal Anesthesia for Thigh Tourniquet Pain During Foot or Ankle Surgery: A Randomized Clinical Trial

Successful management of above knee amputation with combined and modified nerve blocks

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