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

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 Using Peripheral Anesthetic Block of the Foot and Ankle

Foot & Ankle International ◽

10.1177/1071100717739670 ◽

2017 ◽

Vol 39 (2) ◽

pp. 196-200 ◽

Cited By ~ 6

Author(s):

Kelly Cristina Stéfani ◽

Gabriel Ferraz Ferreira ◽

Miguel Viana Pereira Filho

Keyword(s):

Peripheral Nerve ◽

Pain Intensity ◽

Nerve Block ◽

Postoperative Analgesia ◽

Postoperative Period ◽

Peripheral Nerve Block ◽

Control Group ◽

Foot And Ankle ◽

Informed Consent Form ◽

Significant Difference

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 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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