Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective,Randomized Comparison

Abstract

Background:

Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures.

Methods:

All patients having elective outpatient orthopedic forefoot procedures were invited to participate in the study. Patients were prospectively randomized to receive either an ultrasound-guided AB or PFB by a board-certified anesthesiologist prior to their procedure. Intraoperative conversion to general anesthesia and postanesthesia care unit (PACU) opioid requirements were recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until 8 am on postoperative day (POD) 2. Patients rated the effectiveness of the block on a 1 to 5 scale, with 5 being very effective. A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single-shot PFB.

Results:

There was no significant difference in the rate of conversion to general anesthesia between the 2 groups (13.6% [12/88] AB vs 12.7% [10/79] PFB). PACU morphine requirements and doses were significantly reduced in the PFB group (P = .004) when compared to the AB group. The VAS was also significantly lower for the PFB patients at 10 pm on POD 0 (4.6 vs 1.6, P < .001), 8 am on POD 1 (5.9 vs 4.2, P = .003), and 12 pm on POD 1 (5.4 vs 4.1, P = .01). Overall complication rates were similar between the groups (AB 9% vs PFB 10.1%, P = .51) and there were no significant differences in residual sensory paresthesias (AB 2.3% [2/88] vs PFB 5.1% [4/79], P = .29), motor loss (0% vs 0%), or block site pain and/or erythema (AB 6.9% [6/88] vs PFB 5.1% [4/79], P = .44). The analgesic effect of the PFB lasted significantly longer when compared to the ankle block (AB 14.5 hours vs PFB 20.9 hours, P < .001). There was no significant difference in patient-perceived effectiveness of the block between the 2 groups, with both blocks being highly effective (AB 4.79/5 vs PFB 4.82/5, P = .68).

Conclusion:

Regional anesthesia was a safe and reliable adjunct to perioperative pain management and highly effective in patients undergoing elective orthopedic forefoot procedures. However, patients who received a PFB had significantly better pain management and decreased opioid requirements in the immediate perioperative period than patients who received an ankle block.

Level of Evidence:

Level I, prospective randomized study.

Keywords

ankle block popliteal fossa block forefoot disorders outcome studies regional anesthesia

Get full access to this article

View all access options for this article.

References

Anderson

Bohay

Maskill

et al . Complications after popliteal block for foot and ankle surgery. Foot Ankle Int. 2015;36(10):1138-1143.

Capdevila

Dadure

Bringuier

et al . Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial. Anesthesiology. 2006;105(3):566-573.

Clough

Sandher

Bale

Laurence

AS.

The use of a local anesthetic foot block in patients undergoing outpatient bony forefoot surgery: a prospective randomized controlled trial. J Foot Ankle Surg. 2003;42(1):24-29.

Elliot

Pearce

Seifert

Calder

JD.

Continuous infusion versus single bolus popliteal block following major ankle and hindfoot surgery: a prospective, randomized trial. Foot Ankle Int. 2010;31(12):1043-1047.

Gartke

Portner

Taljaard

Neuropathic symptoms following continuous popliteal block after foot and ankle surgery. Foot Ankle Int. 2012;33(4):267-274.

Grosser

Herr

Claridge

Barker

LG.

Preoperative lateral popliteal nerve block for intraoperative and postoperative pain control in elective foot and ankle surgery: a prospective analysis. Foot Ankle Int. 2007;28(12):1271-1275.

Hansen

Eshelman

Cracchiolo

3rd . Popliteal fossa neural blockade as the sole anesthetic technique for outpatient foot and ankle surgery. Foot Ankle Int. 2000;21(1):38-44.

Karaarslan

Tekgul

Simsek

et al . Comparison between ultrasonography-guided popliteal sciatic nerve block and spinal anesthesia for hallux valgus repair. Foot Ankle Int. 2016;37(1):85-89.

McLeod

Wong

Claridge

Merrick

PM.

Lateral popliteal sciatic nerve block compared with subcutaneous infiltration for analgesia following foot surgery. Can J Anaesth. 1994;41(8):673-676.

10.

Provenzano

Viscusi

Adams

Jr et al . Safety and efficacy of the popliteal fossa nerve block when utilized for foot and ankle surgery. Foot Ankle Int. 2002;23(5):394-399.

11.

Rodriguez

Taboada

Carceller

et al . Stimulating popliteal catheters for postoperative analgesia after hallux valgus repair. Anesth Analg. 2006;102(1):258-262.

12.

Samuel

Sloan

Patel

Aglan

Zubairy

The efficacy of combined popliteal and ankle blocks in forefoot surgery. J Bone Joint Surg Am. 2008;90(7):1443-1446.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.25 MB