Foot Surgery in Vanuatu: Results of Combined Tibial, Common Peroneal and Saphenous Nerve Blocks in Fifty-six Adults

Combined tibial and common peroneal nerve anaesthesia was used for foot and ankle surgery in fifty-six adults. Where necessary, the saphenous nerve was also blocked. A calibrated constant current nerve stimulator was used to localise the nerves in the popliteal fossa. Using lignocaine 1%, an opioid premedication, but no other sedation or top-up injection, 60% of the blocks were successful. If a patient felt pain at incision or during surgery, the block was recorded as a failure.

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Nerve Blocks around the Knee in Children

Anaesthesia and Intensive Care ◽

10.1177/0310057x8401200103 ◽

1984 ◽

Vol 12 (1) ◽

pp. 14-17 ◽

Cited By ~ 20

Author(s):

P. M. Kempthorne ◽

T. C. K. Brown

Keyword(s):

Tibial Nerve ◽

Common Peroneal Nerve ◽

Saphenous Nerve ◽

Popliteal Fossa ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Peripheral Nerve Stimulator ◽

Below The Knee ◽

The Common ◽

Equinus Deformity

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.

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Combined Popliteal and Saphenous Nerve Blocks at the Knee

Journal of the American Podiatric Medical Association ◽

10.7547/0940368 ◽

2004 ◽

Vol 94 (4) ◽

pp. 368-374 ◽

Cited By ~ 14

Author(s):

Cornelius M. Donohue ◽

Larry R. Goss ◽

Samuel Metz ◽

Michael S. Weingarten ◽

Larry B. Dyal

Keyword(s):

Peripheral Nerve ◽

Spinal Anesthesia ◽

Lower Leg ◽

Saphenous Nerve ◽

Foot And Ankle ◽

Foot Surgery ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Ankle Surgery ◽

The Common

Peripheral nerve blocks at the ankle have long been used for foot surgery. However, when local foot and ankle blocks are inappropriate or contraindicated, general and spinal anesthesia are the common alternatives. Both have disadvantages and require added equipment and monitors. Combined popliteal and saphenous nerve blocks at the knee can offer a desirable alternative to general and spinal anesthesia for foot and ankle surgery. In addition, popliteal and saphenous nerve blocks provide anesthesia of the entire lower leg, thus permitting a greater variety of procedures to be performed. This article reviews the anatomical considerations, various block techniques, and surgical applications of this useful approach to lower-leg anesthesia. (J Am Podiatr Med Assoc 94(4): 368–374, 2004)

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COMBINED INTEROSSEOUS TIBIAL NERVE AND COMMON PERONEAL NERVE BLOCKS FOR FOOT SURGERY

Anesthesiology ◽

10.1097/00000542-198709001-00288 ◽

1987 ◽

Vol 67 (3) ◽

pp. A288-A288

Author(s):

S. M. Shulman ◽

A. T. C. Peng ◽

K. Nyunt ◽

I. J. Kepes ◽

L. S. Blancato

Keyword(s):

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Foot Surgery ◽

Nerve Blocks

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Safety and Efficacy of the Popliteal Fossa Nerve Block When Utilized for Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/107110070202300504 ◽

2002 ◽

Vol 23 (5) ◽

pp. 394-399 ◽

Cited By ~ 53

Author(s):

David A. Provenzano ◽

Eugene R. Viscusi ◽

Samuel B. Adams ◽

Michael B. Kerner ◽

Marc C. Torjman ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Popliteal Fossa ◽

Anesthetic Technique ◽

Foot And Ankle ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Safety And Efficacy ◽

Ankle Surgery

The popliteal fossa nerve block (PFNB) offers numerous advantages that make it a suitable anesthetic technique for foot and ankle surgery. In this retrospective study, we investigated the acute and long-term safety and efficacy of this relatively underutilized anesthetic technique for foot and ankle surgery. A review of 834 patients who underwent foot and/or ankle surgery by the coauthor (NAA) was conducted. Four hundred sixty-seven patients received a PFNB with the aid of a peripheral nerve stimulator. Variables assessed included the quality of surgical anesthesia, postoperative analgesia and the acute and long-term incidence of postoperative neuralgia and neuropraxia. The PFNBs were performed by anesthesiologists with various levels of training at a tertiary care hospital and all were supplemented with a saphenous nerve block. The PFNB was successful as the sole anesthetic technique in 79% of the cases; 18% were converted to general anesthesia and 3% required augmentation with local anesthetic. There were no complications associated with the PFNB. There were no incidents of postoperative neuralgia or neuropraxia. Only 12% of patients with a successful block required analgesics in the PACU, while 60% of patients with a failed block required systemic analgesics for surgical site pain (p<0.01). These results suggest that the performance of the PFNB with the guidance of a peripheral nerve stimulator is a safe and effective anesthetic technique for foot and ankle surgery.

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

Foot & Ankle International ◽

10.1177/1071100717744331 ◽

2017 ◽

Vol 39 (3) ◽

pp. 332-337 ◽

Cited By ~ 8

Author(s):

Kathleen Jarrell ◽

Elizabeth McDonald ◽

Rachel Shakked ◽

Kristen Nicholson ◽

Vincent Kasper ◽

...

Keyword(s):

Nerve Block ◽

Continuous Flow ◽

Single Injection ◽

Outpatient Setting ◽

Saphenous Nerve ◽

Foot And Ankle ◽

Opioid Use ◽

Nerve Blocks ◽

Catheter Group ◽

Ankle Surgery

Background: The increasing scope and complexity of foot and ankle procedures performed in an outpatient setting require more intensive perioperative analgesia. Regional anesthesia (popliteal and saphenous nerve blocks) has been proven to provide satisfactory pain management, decreased postoperative opioid use, and earlier patient discharge. This can be further augmented with the placement of a continuous-flow catheter, typically inserted into the popliteal nerve region. This study investigated the use of a combined popliteal and saphenous continuous-flow catheter nerve block compared to a single popliteal catheter and single-injection saphenous nerve block in postoperative pain management after ambulatory foot and ankle surgery. Methods: A prospective study was conducted using 60 patients who underwent foot and ankle surgery performed in an outpatient setting. Demographic data, degree of medial operative involvement, American Society of Anesthesiologists physical classification system, anesthesia time, and postanesthesia care unit time were recorded. Outcome measures included pain satisfaction, numeric pain scores (NPS) at rest and with activity, and opioid intake. Patients were also classified by degree of saphenous nerve involvement in the operative procedure, by the surgeon who was blinded to the anesthesia randomization. Results: Patients in the dual-catheter group took significantly less opioid medication on the day of surgery and postoperative day 1 (POD 1) compared to the single-catheter group ( P = .02). The dual-catheter group reported significantly greater satisfaction with pain at POD 1 and POD 3 and a significantly lower NPS at POD 1, 2, and 3. This trend was observed in all 3 subgroups of medial operative involvement. Conclusion: Patients in the single-catheter group reported more pain, less satisfaction with pain control, and increased opioid use on POD 1, suggesting dual-catheter use was superior to single-injection nerve blocks with regard to managing early postoperative pain in outpatient foot and ankle surgery. Level of Evidence: Level II, prospective cohort study.

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A Comparison of Two Methods of Regional Anesthesia

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00464 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0046

Author(s):

Andrew Stith ◽

Matthew Griffin ◽

Thomas Haytmanek ◽

Christopher Hirose

Keyword(s):

Patient Satisfaction ◽

Nerve Block ◽

Local Anesthetic ◽

Single Agent ◽

Saphenous Nerve ◽

Foot And Ankle ◽

Nerve Blocks ◽

Pain Scores ◽

Ankle Surgery ◽

Significant Difference

Category: Other Introduction/Purpose: Poorly controlled post-operative pain is a common cause of patient dissatisfaction. With future emphasis on value-based medicine, optimization of cost-effectiveness and patient satisfaction is critical. Popliteal and saphenous nerve blocks are routinely use in foot and ankle orthopaedic surgery and have become the gold standard for immediate post-operative analgesia. Traditionally a single long-acting local anesthetic agent is utilized which achieves analgesia for 6-24 hours. Recent evidence has shown that multimodal anesthesia with combined anesthetic agents remains effective for a longer duration compared to single-medication nerve blocks. The purpose of this study is to determine if patients undergoing foot and ankle surgery safely benefit from multi-modal compared with traditional single-medication nerve blocks. Methods: This was a two-armed, prospective, randomized, double-blinded study. The study population consisted of 70 patients from a single institution undergoing foot and ankle surgery by two fellowship-trained orthopaedic foot and ankle surgeons. 34 patients received a local anesthetic only popliteal and saphenous nerve block (Bupivacaine) and the other 36 patients received a triple additive nerve block (Dexamethasone, Clonidine, and Buprenorphine) in addition to Bupivacaine. Pre- and Post-operative assessments were performed to determine VAS pain scores, numbness, duration of anesthesia, patient satisfaction with analgesia, and oral pain medication use. Results: Triple additive (TA) nerve block mean duration to onset of pain was longer than for single agent (LA) nerve blocks (40.2 hrs vs 24.3 hrs respectively). Time to complete block resolution was also longer for the TA nerve blocks (82.3 hours) compared to LA blocks (38.7 hrs). 17/34 TA block patients had residual numbness at 1 week compared to 5/36 LA block patients. However, by 3 months there was no difference (8/34 TA and 7/36 LA). There was no significant difference in VAS scores or patient satisfaction rates at 1 week or 3 months. 7/34 TA block patients required narcotic refills compared to 6/36 LA block patients. There was no significant difference in complications between the groups. Conclusion: Triple agent nerve blocks give a longer duration of effective postoperative analgesia compared to single agent blocks. There was a higher rate of lingering numbness in the triple agent blocks at one week but not at 3 months. Patient satisfaction was very high for both groups regardless of their VAS pain scores. Triple agent nerve blocks demonstrate equivalent safety compared with single agent nerve blocks.

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