scholarly journals Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

2021 ◽  
Vol 18 (10) ◽  
pp. 5059
Author(s):  
Beom Suk Kim ◽  
Kyungho Kim ◽  
Jonathan Day ◽  
Jesse Seilern Und Seilern Und Aspang ◽  
Jaeyoung Kim
Keyword(s):  
Surgical Treatment ◽  
Adverse Events ◽  
Nerve Block ◽  
Skin Penetration ◽  
Sensory Block ◽  
Foot And Ankle ◽  
Ingrown Toenail ◽  
Ankle Surgery ◽  
Ingrown Toenails ◽  
Digital Nerve Block

Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.

scholarly journals The Popliteal Nerve Block in Foot and Ankle Surgery: an Efficient and Anatomical Technique

2015 ◽  
Vol 06 (08) ◽  
Author(s):  
Michael B Canales ◽  
Homer Huntley Matthew Reiner ◽  
Duane J Ehredt Mark Razzante
Keyword(s):  
Nerve Block ◽  
Foot And Ankle ◽  
Ankle Surgery

scholarly journals Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Filippo Romanelli ◽  
Malaka Badri ◽  
Naina Rao ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Continuous Infusion ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Complication Risk ◽  
Prospective Comparison ◽  
Ankle Surgery

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]

scholarly journals Liposomal Bupivacaine versus Continuous Popliteal Nerve Block in Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ryan Mulligan ◽  
Joel Morash ◽  
James DeOrio ◽  
Selene Parekh
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Pain Score ◽  
Nerve Block ◽  
Total Ankle Arthroplasty ◽  
Sciatic Nerve Block ◽  
Foot And Ankle ◽  
Ankle Arthroplasty ◽  
Ankle Surgery ◽  
Regional Anesthetic

Category: Ankle, Ankle Arthritis Introduction/Purpose: The use of liposomal bupivacaine (LB) has recently gained popularity in joint arthroplasty. Despite it’s proven safety and efficacy, there is little reported on the use of LB in foot and ankle surgery. Catheter placement for a continuous popliteal sciatic nerve block (CPSNB) has an excellent track record for pain relief, and is commonly used by our group for major foot and ankle reconstructions. The purpose of this study was to compare the use of intraoperative LB injection to CPSNB as a regional anesthetic for total ankle arthroplasty (TAA), with attention to postoperative pain scores, narcotic use, and complications. Methods: Retrospective review of TAA patients treated by two fellowship-trained orthopedic foot and ankle surgeons was performed. Patient demographic data, operative, and postoperative details were collected, including type of regional anesthetic used. Patient’s received either preoperative single-shot popliteal sciatic nerve block with 0.25% bupivacaine followed by intraoperative injection of LB, or preoperative CPSNB alone. Outcomes examined were VAS pain score at 8 hours, 24 hours, 1 week, and 3 weeks following surgery, need for opioid pain medication refill, physician office notification for pain issues or other adverse events, and complications within the first 90 days following surgery. Standard statistical analysis was performed and p < 0.05 was considered significant. Results: 75 patients were identified who underwent TAA and met inclusion criteria. 41 received LB and 34 received CPSNB. No statistical difference was seen between groups with regard to complications, emergency department visits, readmissions, reoperations, VAS pain score at any time point, physician office contacts, and narcotic refills. Mean VAS with LB use was 1.8, 3.5, 2.6, and 2.2 at 8 hours, 24 hours, 1 week, and 3 weeks respectively, compared with mean VAS 2.1, 3.2, 2.2, and 1.9 at similar time points for CPSNB (p=0.59, 0.65, 0.27, and 0.40, respectively). 16 of 41 LB patients needed narcotic refills, versus 12 of 34 CPSNB patients (p=0.81). 3 of 41 LB patients had a complication postoperatively, versus 4 of 34 CPSNB patients. Conclusion: This is the first study evaluating the use of LB for total ankle arthroplasty. LB was both safe and effective for postoperative pain control, with comparable results to CPSNB. As LB gains more widespread use in foot and ankle surgery, further investigation is warranted to determine potential unseen complications and cost-effectiveness.

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

2002 ◽  
Vol 23 (5) ◽  
pp. 394-399 ◽  
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.

scholarly journals Can Ultrasound-Guided Nerve Block Be A Useful Method Of Anesthesia For Tumor Surgery In The Foot And Ankle

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Gi-Soo Lee ◽  
Byung Hak Oh ◽  
Chan Kang ◽  
Yougun Won ◽  
Yoo Jung Park ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
General Anesthesia ◽  
Pain Score ◽  
Nerve Block ◽  
Safe Procedure ◽  
Tumor Surgery ◽  
Block Group ◽  
Foot And Ankle ◽  
Ultrasound Guided ◽  
Anesthetic Effect

Category: Ankle, Tumor Introduction/Purpose: Tumors arising in the foot and ankle are often need surgical treatment. However, there is hesitation about the surgical treatment of anxiety about general anesthesia in some patients. Ultrasound-guided nerve block can be a useful method of anesthesia for tumor surgery in the foot and ankle.This study was performed to compare general anesthesia and ultrasound (US)-guided nerve block for tumor surgery in the foot and ankle. Also, whether US-guided nerve block is a useful method of anesthesia for tumor surgery was investigated. Methods: In this prospective, randomized study, 50 patients who underwent tumor surgery between February 2013 and February 2016 were allocated to two groups: general anesthesia (n = 25, or US-guided nerve block (n = 25). All patients completed a questionnaire with three questions 2 weeks after surgery. For the nerve block group, the procedure duration, interval between the procedure and onset of the anesthetic effect, the point of loss of the anesthetic effect, intraoperative, postoperative visual analog scale (VAS) pain score, and discomfort during surgery were assessed. Results: There was no patient in which the anesthetic was changed to another method during the operation. VAS pain score of postoperative 1 and 6 h was significantly different between the nerve block group (2.2 ± 1.5 and 3.0 ± 1.8, respectively) and general anesthesia group (5.2 ± 3.9 and 5.4 ± 4.5, respectively) Twenty three US-guided nerve block (92%) and 17 general anesthesia patients (68%) reported that they would prefer the same type of anesthesia if they were to undergo tumor surgery in the foot and ankle again; these differences were significant (P < 0.05). There were no long-term complications, such as neurological deficits or infection, after the procedure in all patients. Conclusion: Tumor surgery, such as tumor excision or biopsy, amputation, and other procedures, was performed safely and effectively under US-guided nerve block. These results indicated that US-guided nerve block for tumor surgery is a highly satisfactory and safe procedure without complications and is available for use by any orthopedist.

scholarly journals The efficacy and safety of continuous versus single-injection popliteal sciatic nerve block in outpatient foot and ankle surgery: a systematic review and meta-analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Single Injection ◽  
Meta Analysis ◽  
Sciatic Nerve Block ◽  
Cochrane Library ◽  
Foot And Ankle ◽  
Efficacy And Safety ◽  
Outcome Parameters ◽  
Ankle Surgery

Abstract Background Continuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. Its efficacy as well as safety is yet to be established. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB. Methods We performed a comprehensive literature review on Web of Science, the Cochrane Library, PubMed and Embase and only included randomized controlled trials (RCTs). Five RCTs that compared the efficacy and safety of CPSNB with the single-injection popliteal sciatic nerve block group were included. The primary outcome parameters were visual analog scale (VAS) scores at postoperative 24, 48 and 72 h. The secondary outcome parameters were amount of oral analgesics consumed, overall patient satisfaction and need of admission after surgery. A sensitivity analysis was performed to explore the consistency of the results. Results In comparison with the single-injection group, CPSNB was associated with a lower VAS score at postoperative 24 and 48 h (p < 0.05). There were no neuropathic symptoms or infection events after the nerve block. However, there were several minor complications associated with the pump and catheter system, with drug leakage being the most common complication (N = 26 of 187, 13.9%). Conclusion CPSNB is an effective method in pain management for outpatient foot and ankle surgery. Both methods appear to be safe as none of the patients experienced neuropathic symptoms or infection. Further studies with larger sample size are needed to compare the risk of major complications between the two methods. Level of evidence I; meta-analysis.

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