Postoperative Analgesia Using Peripheral Anesthetic Block of the Foot and Ankle

Background: Anesthetic block of the peripheral nerves in the foot and ankle is generally used as anesthesia. The increased use of anesthetic blocks has made this technique an increasingly safe method, and its use has been expanded to postoperative analgesia in foot and ankle surgeries. The objective of this study was to evaluate the analgesia time and pain intensity, using objective scores, after peripheral nerve block in foot and ankle surgeries. Methods: Patients who underwent surgery by the foot and ankle group of our institution from March 2016 to January 2017 were invited to participate in this prospective, randomized, and blinded study after signing an informed consent form. The study was approved by the local ethics committee. In total, 57 patients and 59 feet (2 bilateral surgeries) were subjected to spinal anesthesia and were randomized into the group receiving peripheral nerve block in the foot and ankle (7.5 mg/mL ropivacaine) and the control group. The patients answered a questionnaire, administered by phone during the postoperative period, regarding measurement of pain intensity, using the visual analog scale (VAS), and the time of onset of pain. Results: Improved pain was noted in patients who received a supplemental peripheral nerve block in relation to the duration of postoperative analgesia and the intensity of pain during the immediate postoperative period. No significant difference was found between the 2 groups in terms of pain intensity on the first or second postoperative day. Conclusion: Peripheral nerve block in the foot and ankle region can be used effectively as postoperative analgesia to reduce pain intensity during the immediate postoperative period and prolong analgesia. Level of Evidence: Level I, high-quality prospective randomized clinical trial.

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Postoperative analgesia with the use of peripheral nerve block of the foot and ankle

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00462 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0046

Author(s):

Kelly Stéfani ◽

Gabriel Ferraz

Keyword(s):

Peripheral Nerve ◽

Pain Intensity ◽

Nerve Block ◽

Postoperative Analgesia ◽

Postoperative Period ◽

Peripheral Nerve Block ◽

Control Group ◽

Study Group ◽

Foot And Ankle ◽

The Mean

Category: Basic Sciences/Biologics Introduction/Purpose: Peripheral nerve block in the foot and ankle is usually used for anesthesia in forefoot and midfoot surgeries. However, since the postoperative analgesia obtained is prolonged, we can expand its use, as an adjuvant after the end of the spinal or general anesthesia. The aim of this study was to evaluate the use of peripheral nerve block of the foot and ankle as a method of postoperative analgesia. Methods: A prospective, randomized, blinding study was performed. The study group included 30 patients (32 feet) submitted to peripheral anesthetic block after surgery with spinal anesthesia and the control group (30 patients, 31 feet) were patients not submitted to nerve block. The inclusion criterion was: patients submitted to foot and ankle surgery at our institution. Patients answered the questionnaire postoperatively, with the measurement of pain intensity by the Visual Analog Scale (VAS) and the time of onset of pain. All local peripheral block was performed by the same orthopedic team with 20 mL of Ropivacaine at a concentration of 7.5 mg / mL (0.75%). Results: The mean patient age was 52,5 years, and the majority of patients were women (66%). The results showed a statistically significant difference between the control group and the study group, with a longer time of postoperative analgesia (p <0.001) and lower pain intensity in the immediate postoperative period (p <0.001) in patients submitted to blockade anesthetic. There was no statistical difference between the two groups regarding pain intensity on the first and second postoperative day. Conclusion: In the study group, the mean postoperative pain (six hours after surgery) was lower when compared to the control group, with statistical significance. This result showed that the ankle block helped to control pain, in a safe and effective mode. The use of ropivacaine presents a sensitive block similar to bupivacaine, but with shorter motor block, allowing early initiation of rehabilitation. The study demonstrated that peripheral nerve block in the foot and ankle region can be used effectively in postoperative analgesia, reducing pain intensity in the immediate postoperative period and also prolonging analgesia and thus maximizing physiotherapy postoperative period.

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Postoperative analgesia with the use of peripheral nerve block of the foot and ankle

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.448 ◽

2017 ◽

Vol 23 ◽

pp. 118

Author(s):

K. Stéfani ◽

M. Pereira Filho ◽

G. Ferraz

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Postoperative Analgesia ◽

Peripheral Nerve Block ◽

Foot And Ankle

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Combination Preemptive Peripheral Nerve Block in Limb Surgery. A Prospective Study

Medicina ◽

10.3390/medicina56080388 ◽

2020 ◽

Vol 56 (8) ◽

pp. 388

Author(s):

I-Cheng Lu ◽

Shu-Hung Huang ◽

David Vi Lu ◽

Chun Dan Hsu ◽

Sheng Hua Wu

Keyword(s):

Pain Management ◽

Peripheral Nerve ◽

Nerve Block ◽

Peripheral Nerve Block ◽

Recovery Period ◽

Controlled Study ◽

Control Group ◽

Single Shot ◽

Early Recovery ◽

The Impact

Background and objectives: Patients often suffer from moderate to severe pain during the early recovery period in orthopedic surgery. We investigated the impact of a single-shot preoperative peripheral nerve block (PNB) on post-anesthesia recovery parameters and interleukin (IL)-6 level during limb surgery. Materials and Methods: A prospective randomized controlled study was conducted, and patients scheduled for limb surgery were recruited. Sixty patients were randomly assigned to either the PNB group or control group, who received morphine as a primary analgesic. The peak verbal numeric rating scale (NRS) score in the post-anesthesia care unit (PACU) was evaluated as a primary outcome. We also recorded rescue analgesics requirement and wake-up time from anesthesia in the PACU. In addition, the change of plasma IL-6 level after incision was measured. Results: Fifty-two patients completed the study, 27 and 25 cases in the PNB and control group, respectively. Preemptive PNB significantly reduced peak NRS score in the PACU compared to control group. Lower rescue analgesics requirement and rapid wake-up from anesthesia were also noted in PNB group. The IL-6 concentration increased less in the PNB group at 2 h after incision. Conclusions: Preemptive PNB attenuates IL-6 expression 2 h after incision and improves pain management in the PACU. PNB was considered as an essential part of pain management in limb surgery.

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Postoperative Analgesia After Peripheral Nerve Block for Podiatric Surgery

Survey of Anesthesiology ◽

10.1097/00132586-199708000-00050 ◽

1997 ◽

Vol 61 (4) ◽

pp. 241

Author(s):

DOUGLAS J. REINHART ◽

WEIPENG WANG ◽

KELLY S. STAGG ◽

KEVIN G. WALKER ◽

PETER L. BAILEY ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Postoperative Analgesia ◽

Peripheral Nerve Block ◽

Podiatric Surgery

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Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-101208 ◽

2020 ◽

Vol 45 (6) ◽

pp. 399-404 ◽

Cited By ~ 1

Author(s):

Hiroaki Abe ◽

Masahiko Sumitani ◽

Hiroki Matsui ◽

Shotaro Aso ◽

Reo Inoue ◽

...

Keyword(s):

Propensity Score ◽

Lower Extremity ◽

Peripheral Nerve ◽

General Anesthesia ◽

Nerve Block ◽

Postoperative Delirium ◽

Peripheral Nerve Block ◽

Lower Extremity Amputation ◽

Significant Difference ◽

Extremity Amputation

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.

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The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients

Frontiers in Medicine ◽

10.3389/fmed.2018.00057 ◽

2018 ◽

Vol 5 ◽

Cited By ~ 2

Author(s):

Dušica Simić ◽

Marija Stević ◽

Zorana Stanković ◽

Irena Simić ◽

Siniša Dučić ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Peripheral Nerve Block ◽

Safety And Efficacy ◽

Continuous Peripheral Nerve Block

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Comparative of the Effectiveness of Different Objective Method for Infraclavicular Brachial Plexus Block Success; Which One of Them is A Reliable and Early Indicator?

10.1101/2021.06.26.21259567 ◽

2021 ◽

Author(s):

Abdulhakim Sengel ◽

Mahmut alp Karahan ◽

Nuray Altay ◽

Orhan Binici ◽

Veli fahri Pehlivan ◽

...

Keyword(s):

Body Temperature ◽

Peripheral Nerve ◽

Nerve Block ◽

Peripheral Nerve Block ◽

Temperature Measurements ◽

Tissue Oxygen Saturation ◽

Block Success ◽

Significant Difference ◽

Plexus Block ◽

Tissue Hemoglobin

ABSTRACT BACKGROUND Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. OBJECTIVE This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI) and body temperature are reliable and objective methods to evaluate the adequacy of infraclavicular blockage. DESIGN A prospective observational study. SETTING Single center, Department of Anesthesiology, Harran University Medical Faculty, Turkey, from February 2019 to December 2019. PATIENTS A total of 100 patients scheduled to undergo forearm surgery. INTERVENTION Ultrasound-guided infraclavicular block (ICB) in 100 patients undergoing forearm surgery. MAIN OUTCOME MEASURES PI, SpHb, StO2, THI and Body Temperature measurements were recorded 5 min before the block procedure, right after the procedure, and until the 25th minute after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups. RESULTS Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2 (P = 0.001), THI (P = 0.001), PI (P = 0.001) and body temperature (P = 0.001), there was no significant difference between these groups in terms of SpHb (P > 0.05). Moreover, a significant difference was detected between the groups of successful block and failed block in terms of StO2 (P = 0.002), PI (P = 0.002) and body temperature (P = 0.005), while there was no significant difference between these groups in terms of THI (P > 0.05) and SpHb (P > 0.05). CONCLUSION StO2, PI and body temperature measurements are the simple, objective, noninvasive techniques to be used to evaluate success of block procedures. According to The receiver operating characteristic (ROC) analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.

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