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

Saporito, Andrea; Петри, Г; Sturini, Evelina; Borgeat, Alain; Aguirre, José

doi:10.1097/eja.0000000000000027

Cited by 11 publications

(3 citation statements)

References 33 publications

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“…Yes 88,92,134,194,200 No 9,[12][13][14][15]18,19,[77][78][79][80][81]100,128,162,165,174,457,458 A recent RCT provided 3 d of popliteal sciatic infusion to all participants (n = 120) and randomized subjects to remain hospitalized for 0 vs 2 nights after major orthopedic foot surgery 194 ; total costs of care were decreased 79% in the early discharge group, and no other differences between treatments were detected, including pain scores, complications, and readmission rates Tibial, superficial peroneal and deep peroneal nerves…”

Section: Poplitealmentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

283

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A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim. Novel insertion sites include the adductor canal, interpectoral, quadratus lumborum, lesser palatine, ulnar, superficial, and deep peroneal nerves. Noteworthy new indications include providing analgesia after traumatic rib/femur fracture, manipulation for adhesive capsulitis, and treating abdominal wall pain during pregnancy. The preponderance of recently published evidence suggests benefits nearly exclusively in favor of catheter insertion using ultrasound guidance compared with electrical stimulation, although little new data are available to help guide practitioners regarding the specifics of ultrasound-guided catheter insertion (eg, optimal needle-nerve orientation). After some previous suggestions that automated, repeated bolus doses could provide benefits over a basal infusion, there is a dearth of supporting data published in the past few years. An increasing number of disposable infusion pumps does now allow a similar ability to adjust basal rates, bolus volume, and lockout times compared with their electronic, programmable counterparts, and a promising area of research is communicating with and controlling pumps remotely via the Internet. Large, prospective studies now document the relatively few major complications during ambulatory CPNB, although randomized, controlled studies demonstrating an actual shortening of hospitalization duration are few. Recent evidence suggests that, compared with femoral infusion, adductor canal catheters both induce less quadriceps femoris weakness and improve mobilization/ambulation, although the relative analgesia afforded by each remains in dispute. Newly published data demonstrate that the incidence and/or severity of chronic, persistent postsurgical pain may, at times, be decreased with a short-term postoperative CPNB. Few new CPNB-related complications have been identified, although large, prospective trials provide additional data regarding the incidence of adverse events. Lastly, a number of novel, alternative analgesic modalities are under development/investigation. Four such techniques are described and contrasted with CPNB, including single-injection peripheral nerve blocks with newer adjuvants, liposome bupivacaine used in wound infiltration and peripheral nerve blocks, cryoanalgesia with cryoneurolysis, and percutaneous peripheral nerve stimulation.

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Section: Poplitealmentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

283

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“…Compared with inpatient management, surgery in an outpatient setting using regional anesthesia has been shown to result in significantly lower costs without an increase in clinical complications. 16 For foot and ankle surgery specifically, performing total ankle arthroplasty as an outpatient procedure resulted in a cost savings of $2500 per patient while outpatient management of complex hindfoot and ankle surgery showed a 54% reduction in costs compared with inpatient management. 6,11 Furthermore, in the current study, there were no readmissions or need for emergency room visits in either group, suggesting an additional economic advantage that further facilitates increasing the types of foot and ankle procedures that can be done in an outpatient setting rather than a traditional inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Combined Popliteal Catheter With Single-Injection vs Continuous-Infusion Saphenous Nerve Block for Foot and Ankle Surgery

et al. 2017

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“…4 In addition to these cited advantages, outpatient surgery improves subjective measures of patient comfort and quality of life while also decreasing the risk of nosocomial infections. 5-7 However, hindfoot arthrodesis in the outpatient setting should not be universally applied because patients with complex deformities, multiple comorbidities, and other risk factors will likely need closer monitoring postoperatively in the inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

A Safety and Cost Analysis of Outpatient Versus Inpatient Hindfoot Fusion Surgery

Moon

McGee

Patel

et al. 2018

Foot & Ankle Specialist

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Background. Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost savings of these procedures compared with the risks and benefits has not been clearly investigated. The objective of this study was to compare patient characteristics, costs, and short-term complications between inpatient and outpatient procedures. Methods. This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures by a single surgeon, at 1 academic institution, from 2013 to 2017. Data collected included demographics, operative variables, comorbidities, complications, costs, and subsequent reencounters. Results. Of 124 procedures, 34 were inpatient and 90 were outpatient. Between procedural settings, with the numbers available, there was no significant increase in complication rate or frequency of reencounters within 90 days. There were no significant differences in the number of patients with reencounters related to the index procedure within 90 days (P = .43). There were 30 reencounters within 90 days after outpatient surgery versus 4 after inpatient surgery (P = .05). The total number of emergency room visits in the outpatient group within 90 days was significantly higher compared with the inpatient group (P = .04). The average cost for outpatient procedures was US$4159 less than inpatient procedures (P < .0001). Conclusion. Outpatient hindfoot fusion may be a safe alternative to inpatient surgery, with significant overall cost savings and similar rate of short-term complications. On the basis of these findings, we believe that outpatient management is preferable for the majority of patients, but further investigation is warranted. Levels of Evidence: Level III

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

Cited by 11 publications

References 33 publications

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Combined Popliteal Catheter With Single-Injection vs Continuous-Infusion Saphenous Nerve Block for Foot and Ankle Surgery

A Safety and Cost Analysis of Outpatient Versus Inpatient Hindfoot Fusion Surgery

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