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Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Anesthesiol Clin 2024; 42:263-280. [PMID: 38705675 DOI: 10.1016/j.anclin.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
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Affiliation(s)
- Christopher M Sharrow
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Brett Elmore
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA.
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2
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Park YU, Joe HB, Lee JW, Seo YW. Analgesic effectiveness of continuous versus single-injection adductor canal block in addition to continuous popliteal sciatic nerve block for bimalleolar and trimalleolar ankle fracture surgery: Prospective randomized controlled trial. J Orthop Sci 2024:S0949-2658(24)00004-6. [PMID: 38316570 DOI: 10.1016/j.jos.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The adductor canal block is a well-known procedure for controlling postoperative pain after medial malleolus fracture surgery. Continuous nerve block is a viable option for blocking pain for a longer period although the literature on this subject is scarce. Therefore, this study aimed to compare continuous adductor canal block (cACB) group to single-injection adductor canal block (sACB) group in those with bimalleolar or trimalleolar ankle fractures. The procedure was performed in addition to a continuous sciatic nerve block for postoperative pain relief and patient satisfaction. METHODS The study included 57 patients who had bimalleolar or trimalleolar ankle fractures and underwent open reduction and internal fixation between August 2016 and June 2018. Each patient received a continuous sciatic nerve block and was divided into two groups: those who received cACB and those who received sACB. Each postoperative pain was scored at 4, 8, 12, 24, 48, and 72 h after surgery. Additionally, the consumption of rescue medications and patient satisfaction were evaluated. RESULTS The two groups displayed no disparity in medial side ankle pain at 4 h and 8 h after surgery, but significantly higher pain in the sACB group at 12, 24, 48, and 72 h after surgery. However, there was no difference in the pain at the lateral side of ankle and consumption of rescue medication. In addition, the cACB group showed more satisfaction than the sACB group did. CONCLUSION CACB is better than sACB in terms of postoperative pain control and patient satisfaction. cACB can be used for postoperative pain control in ankle fractures involving the medial malleolus. LEVEL OF EVIDENCE Prospective Randomized Controlled Trial, Level 2.
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Affiliation(s)
- Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Han Bum Joe
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong Wha Lee
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Young Wook Seo
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
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3
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Abd-Elsayed A, Tanios M, Kodsy M. Ankle joint articular nerves. RADIOFREQUENCY ABLATION TECHNIQUES 2024:78-87. [DOI: 10.1016/b978-0-323-87063-4.00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Kawabata S, Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Sakurai S, Moriwaki D, Adachi N. Safe Insertion Angle of the Suture Button to Avoid Saphenous Structure in Syndesmosis Injury. Foot Ankle Spec 2023:19386400231213761. [PMID: 38018519 DOI: 10.1177/19386400231213761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
In placing the medial suture button for syndesmosis injury, the risk of great saphenous vein and saphenous nerve injury has been reported. This study aimed to determine the safe insertion angle of the guide pin to avoid saphenous structure injury during suture button fixation. The incidence of saphenous structure injury was investigated using 8 legs of cadavers. The greater saphenous vein was depicted on the skin using near-infrared light (VeinViewer® Flex) and the distance between the greater saphenous vein and the posterior edge of the tibia at levels of 10, 20, and 30 mm from the joint line of the tibiotalar joint was measured in the 60 legs of healthy participants. On computed tomography (CT) images, the angles between the greater saphenous vein and transmalleolar axis at levels of 10, 20, and 30 mm from the joint line of the tibiotalar joint were measured. The cadaveric study revealed that the percentages of contact with the saphenous nerve were 8.3% to 16.7%. Using near-infrared light, the vein and tibia distance was 32.9 ± 6.8 mm of 10 mm, 26.6 ± 6.4 mm of 20 mm, and 20.4 ± 6.4 mm of 30 mm. The angle between the vein and transmalleolar axis was 1.0° to 9.4°, and more proximal, the angle was smaller. The veins depicted by near-infrared light can be a landmark to identify great saphenous vein, and injury of the saphenous structure can be prevented using VeinViewer Flex or considering the insertion angle defined in this study when placing the suture button for syndesmosis injuries.Level of Evidence: Level IV.
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Affiliation(s)
- Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dan Moriwaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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5
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Çiçek F, Koç T, Olgunus ZK. Connection between medial dorsal cutaneous nerve and saphenous nerve: case report. Surg Radiol Anat 2023; 45:1233-1237. [PMID: 37528298 DOI: 10.1007/s00276-023-03214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE There are no data on the connection of the saphenous nerve (SN), located on the medial side of the foot, with the terminal branches of the superficial fibular nerve. The aim of this study is to reveal the variation that surgeons should pay attention to for anesthesia applied in foot surgeries. METHODS In this study, the left foot of a 70-year-old female cadaver fixed with formalin was dissected. The distance to the medial malleolus and the incision line was recorded using digital caliper to determine the reference points in the resulting variation. RESULTS It was observed that a branch from the SN, which arose from the SN and proceeded anteriorly to the upper part of the medial malleolus and continued towards the dorsum of the foot, hooked with a branch from the medial dorsal cutaneous nerve (MDCN). The branches arising from this hook were distributed on the medial edge of the foot up to the proximal metatarsophalangeal joint I. The distance of this nerve connection to the medial malleolus is 91.14 mm, and the distance to the incision line is 15.76 mm. CONCLUSIONS It is suggested that the case presented as an unusual SN variation, which may affect the success of local anesthesia in invasive procedures to the medial part of the foot and could be considered in the evaluation of sensory loss after anteromedial surgical approach to the ankle, should be included in the classification of the cutaneous innervation pattern of the foot.
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Affiliation(s)
- Fatih Çiçek
- Department of Anatomy, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Türkiye.
| | - Turan Koç
- Department of Anatomy, School of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
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Finkelstein ER, Buitrago J, Jose J, Levi AD, Xu KY, Burks SS. Lower extremity peripheral nerve pathology: Utility of preoperative ultrasound-guided needle localization before operative intervention. Skeletal Radiol 2023; 52:1997-2002. [PMID: 37060462 DOI: 10.1007/s00256-023-04347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Historically, the use of ultrasound (US) in the management of peripheral nervous system (PNS) pathology has been limited to diagnostic confirmation or guidance for interventional injections. This technical case series will demonstrate the utility and versatility of preoperative US-guided needle localization for the excision of lower extremity neuromas and other pathology of the PNS. Five patients with symptomatic lower extremity PNS tumors were retrospectively reviewed. This case series corroborates the technical nuances of localizing lower extremity neuromas by US-guided needle and wire placement prior to operative excision. This was achieved by a multidisciplinary team that included plastic surgery, neurosurgery, and radiology. Five patients had US-guided needle localization of a lower extremity PNS target prior to operative intervention. Three patients had lower extremity neuromas of varying origins, including the lateral femoral cutaneous nerve (LFCN), saphenous nerve, and sural nerve. The remaining two patients had a sciatic nerve sheath Schwannoma and a femoral nerve glomus tumor. Under sonographic visualization, a needle was advanced to the target perimeter and withdrawn, leaving behind a percutaneous guidewire. This technique simplified the marking of the nerve course prior to dissection and led to efficient intraoperative identification of all five PNS tumors without any complications. Preoperative US-guided needle localization led to safe, accurate, and efficient perioperative and intraoperative identification of neuromas and other PNS tumors of the lower extremity prior to excision. By reducing the challenges of nerve identification in a scarred tissue bed, this multidisciplinary approach may decrease postoperative patient morbidity.
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Affiliation(s)
- Emily R Finkelstein
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA.
| | - Joanne Buitrago
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jean Jose
- Department of Clinical Radiology, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Allan D Levi
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Kyle Y Xu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - S Shelby Burks
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
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Schnack LL, Rodriguez-Collazo ER, Oexeman SA, Costa AJ. The Reset Neurotomy within a Nonidentifiable Zone of Injury after Trauma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5316. [PMID: 37842076 PMCID: PMC10569763 DOI: 10.1097/gox.0000000000005316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
Recent reconstructive approaches to peripheral nerve surgery have been directed toward active approaches; one such approach is nerve grafting the injured nerve segment. Addressing a nerve injury proximal to the zone of injury has demonstrated reproducible results in preventing symptomatic neuroma formation. A 53-year-old woman with a history of an ankle fracture presented with neuritic symptoms that interfered with her activities of daily living. Her intractable pain was significantly but temporarily relieved with in-office nerve blocks to the superficial peroneal nerve and sural nerve. There were no identifiable zones of injury in the nerve conduction study. Orthopedic etiology was ruled out. Nerve allografts, each 3 cm in length, were utilized with conduits and placed at the location proximal to the zone of maximum tenderness. Once the neurotomy was performed, the nerve allografts and conduits were coapted to each nerve. The patient's intractable neuritic pain was relieved even 15 months postoperatively. The visual analog scale went from eight of 10 preoperatively to two of 10 postoperatively. Additional nerve conduction studies were not needed, and the patient returned to daily activities once the skin incisions healed. The reset neurotomy is an option for the microsurgical surgeon to have for patients with a nonidentifiable zone of injury or no identifiable neuroma but presents with intractable nerve pain relieved by local anesthetic nerve blocks.
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Affiliation(s)
- Lauren L Schnack
- From the Department of Podiatric Medicine and Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Edgardo R Rodriguez-Collazo
- Ascension-Saint Joseph Chicago Podiatry Residency Program, Chicago, Ill
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Stephanie A Oexeman
- Ascension-Saint Joseph Chicago Podiatry Residency Program, Chicago, Ill
- Oexeman Foot and Ankle, PLLC, Chicago, Ill
| | - Andrew J Costa
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Ill
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Donahue GS, Hagemeijer NC, Johnson AH. Republication of "How Will the Foot and Ankle Orthopedic Community Respond to the Growing Opioid Epidemic?". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193423. [PMID: 37566702 PMCID: PMC10411272 DOI: 10.1177/24730114231193423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
In the midst of the current opioid crisis, it has become critically important to properly manage opioid-prescribing patterns for the treatment of postoperative pain. There is currently a scarcity of literature specifying prescription and consumption patterns following orthopedic surgery and specifically foot and ankle surgery. Clinical guidelines for postoperative pain management are deficient.
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Affiliation(s)
| | | | - Anne Holly Johnson
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clin Sports Med 2022; 41:263-280. [PMID: 35300839 DOI: 10.1016/j.csm.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
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10
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Beard NM. Nerve Ablation in the Foot and Ankle. Phys Med Rehabil Clin N Am 2021; 32:803-818. [PMID: 34593145 DOI: 10.1016/j.pmr.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ablation therapies in the foot and ankle are accessible adjuncts to surgery and comprehensive pain management in recalcitrant pain syndromes. Techniques are best applied to individual patient anatomy with strong advantages in a working knowledge of neuromuscular real-time imaging with ultrasound. Interventionists face the unique challenge in this region of preserving balance and proprioception as well as intrinsic muscle function, while optimizing pain relief. A decision-making approach emphasizing selectivity by using regional and target-specific ablations is optimal. This article reviews basic technique, approaches, potential complications, and ultrasound anatomy for a practical introduction to ablation options in the foot and ankle.
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Affiliation(s)
- Nahum M Beard
- Faculty Campbell Clinic Sports Medicine Fellowship, Department of Orthopaedic Surgery and Rehabilitation, Department of Family Medicine, University of Tennessee Health Science Center, 1400 South Germantown Road, Germantown, TN 38138, USA.
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11
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Nirenberg MS, Ansert EA. Saphenous Nerve Denervation for Chronic Pain After Compartment Syndrome of the Foot. J Am Podiatr Med Assoc 2021; 111. [PMID: 34861688 DOI: 10.7547/20-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Denervation has been a recommended treatment option for a range of pathologies, including relief from chronic pain; however, literature discussing complete denervation of the distal saphenous nerve for foot pain has not been found. A case report of surgical decompression for compartment syndrome resulting in chronic, debilitating foot pain that was successfully alleviated by complete saphenous nerve denervation is presented. The predominant area of the patient's pain was on the medial aspect of the foot, where a thickened scar from a decompression fasciotomy was noted. The patient's initial pain score was reported as 10 of 10, with no relief from numerous conservative treatments attempted over an 11-year period. After a diagnostic injection of a local anesthetic to the distal saphenous nerve provided the patient with immediate, temporary relief, complete denervation of the distal saphenous nerve was performed. The patient reported significant pain reduction shortly after the procedure. This case suggests that physicians should be cognizant of the saphenous nerve and its branches, as well as its variable pathways during surgery. In addition, practitioners should be aware of its influence as a progenitor of pain in the foot that may require denervation.
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Abstract
This article addresses the importance of anesthesiologists providing regional anesthesia techniques that are beneficial to the care of trauma patients in the field. It also discusses the advantages and risks associated with regional anesthesia in the field along with how to avoid those risks. In addition, it describes some of the benefits of modern ultrasound techniques compared with landmark techniques with stimulation and other important considerations when performing regional anesthesia in the field. The article gives the unique indications, risks, and key points of the most useful regional techniques for anesthesiologists operating in field environments.
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Affiliation(s)
- Robert Vietor
- Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Chester Buckenmaier
- Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Hamada T, Matsubara H, Hikichi T, Tsuchiya H. Evaluating the course of the saphenous vein and nerve for risk assessment in the suture button technique. Sci Rep 2021; 11:131. [PMID: 33420271 PMCID: PMC7794578 DOI: 10.1038/s41598-020-80556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/18/2020] [Indexed: 12/04/2022] Open
Abstract
The suture button technique can cause damage to the saphenous vein and nerve. We examined the location and course of the great saphenous vein using magnetic resonance imaging and determined its position at 10, 20, 30, or 40 mm proximal to the tibial plafond. We divided the region from the anterior to the posteromedial tibial edges into segments A, B, C, D, and E, and compared baseline data and vein parameters between 56 healthy (group H) and 296 symptomatic limbs (group D). At 10, 20, 30, and 40 mm proximal to the tibial plafond, segments A (53.4%), B (45.7%), C (50.0%), and D (52.6%), respectively, had the highest probability of the presence of the great saphenous vein. The mean angle of the great saphenous vein from the distal anterior to the proximal posterior side of the tibia in relation to the tibial axis was 32.4° ± 4.8°. There were no significant differences between groups H and D. These findings indicate that the position of the saphenous vein and nerve should be determined prior to performing the suture button technique on the medial side of the tibia. This can be achieved under direct visualization through a small skin incision or via ultrasound.
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Affiliation(s)
- Tomo Hamada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Toshifumi Hikichi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Boyd BS, Doty JF, Kluemper C, Kadakia AR. Anatomic Risk to the Neurovascular Structures With a Medially Based All-Inside Syndesmosis Suture Button Technique. J Foot Ankle Surg 2020; 59:95-99. [PMID: 31882155 DOI: 10.1053/j.jfas.2019.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023]
Abstract
Recent evidence suggests that the use of suture button devices for ankle syndesmosis fixation is increasing. Multiple studies have shown some concern about damaging the greater saphenous neurovasculature with placement of the anchor point on the medial tibial cortex. We hypothesized that an all-inside button deployment technique would allow for a low risk to medial soft tissue structures. A total of 40 syndesmosis suture buttons were placed into 10 separate cadaveric lower limbs, using the newly developed technique. Four suture buttons were sequentially placed from distal to proximal in each limb within the zone of typical syndesmosis fixation, using fluoroscopic guidance. A medial incision was then performed to evaluate the relationship of the suture buttons to the medial soft tissue structures and the medial malleolus. Thirteen of 40 suture buttons (32.5%) were placed anterior, 7 (17.5%) posterior, and 20 (50%) with a portion of the button directly deep to the saphenous vein. Two of 40 buttons (5%) were placed within the tibial periosteum, and 38 (95%) were subfascial and directly superficial to the periosteum. Four of 40 (10%) limbs revealed a perforation in the saphenous vein from the guidepin. In conclusion, risks to the medial neurovascular structures exist with the medial deployment technique, but they appear to be mitigated compared with previous publications. The necessity of a medial incision to evaluate for soft tissue entrapment may not be necessary in all patients, as this technique appears to be safe, accurate, and reproducible.
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Affiliation(s)
- Brandon S Boyd
- PGY-4 Orthopedic Resident, The University of Tennessee, Chattanooga, TN.
| | - Jesse F Doty
- Assistant Professor and Director of Foot and Ankle Surgery, The University of Tennessee, Chattanooga, TN
| | - Chase Kluemper
- PGY-6 Orthopedic Fellow, Philadelphia Hand to Shoulder Center, Philadelphia, PA
| | - Anish R Kadakia
- Associate Professor and Program Director, Foot and Ankle Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL
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15
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Lehtonen EJ, Pinto MC, Patel HA, Dahlgren N, Abyar E, Shah A. Syndesmotic Fixation With Suture Button: Neurovascular Structures at Risk: A Cadaver Study. Foot Ankle Spec 2020; 13:12-17. [PMID: 30712382 DOI: 10.1177/1938640019826699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to describe the anatomic variations in the saphenous nerve and risk of direct injury to the saphenous nerve and greater saphenous vein during syndesmotic suture button fixation. METHODS Under fluoroscopic guidance, syndesmotic suture buttons were placed from lateral to medial at 1, 2, and 3 cm above the tibial plafond on 10 below-knee cadaver leg specimens. The distance and position of each button from the greater saphenous vein and saphenous nerve were evaluated. RESULTS The mean distance of the saphenous nerve to the suture buttons at 1, 2, and 3 cm were 7.1 ± 5.6, 6.5 ± 4.6, and 6.1 ± 4.2, respectively. Respective rate of nerve compression was as follows, 20% at 1 cm, 20% at 2 cm, and 10% at 3 cm. Mean distance of the greater saphenous vein from the suture buttons at 1, 2, and 3 cm was 8.6 ± 7.1, 9.1 ± 5.3, and 7.9 ± 4.9 mm, respectively. Respective rate of vein compression was 20%, 10%, and 10%. A single nerve branch was identified in 7 specimens, and 2 branches were identified in 3 specimens. CONCLUSION There was at least one case of injury to the saphenous vein and nerve at every level of button insertion at a rate of 10% to 20%. Neurovascular injury may occur despite vigilant use of fluoroscopy and adequate surgical technique. Further investigation into the use of direct medial visualization of these high-risk structures should be done to minimize the risk. Levels of Evidence: Therapeutic, Level II: Prospective, comparative study.
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Affiliation(s)
- Eva J Lehtonen
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martim C Pinto
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harshadkumar A Patel
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas Dahlgren
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eildar Abyar
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Dang DY, McGarry SM, Melbihess EJ, Haytmanek CT, Stith AT, Griffin MJ, Ackerman KJ, Hirose CB. Comparison of Single-Agent Versus 3-Additive Regional Anesthesia for Foot and Ankle Surgery. Foot Ankle Int 2019; 40:1195-1202. [PMID: 31307211 DOI: 10.1177/1071100719859020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery. METHODS Eighty patients undergoing foot and ankle surgery over a 9-month period were prospectively enrolled and randomized to receive a peripheral nerve block containing either a single anesthetic (SA) or one with 3 additives (TA). Patients, surgeons, and anesthesiologists were blinded to the groups. Patients maintained pain diaries and were evaluated at 1 and 12 weeks postoperatively. Fifty-six patients completed the study. RESULTS The TA group had a longer duration of analgesic effect than the SA group (average 82 vs 34 hours, P < .05). Forty-eight hours after surgery, 93% of SA blocks, compared with 34% of TA blocks, had completely worn off. The TA group had a longer duration of sensory effects. At 3 months, 10 of 26 (38.5%) TA patients, compared with 3 of 30 (10%) SA patients, reported postoperative neurologic symptoms. Pain scores in both groups were not statistically different at 1 week or 3 months after surgery. Patients in both groups were similarly satisfied with their blocks. CONCLUSION Both types of nerve blocks provided equivalent pain control and patient satisfaction in patients undergoing foot and ankle surgery. The 3-additive agent blocks were associated with a longer duration of pain relief and a longer duration of numbness, as well as higher rates of postoperative neurologic symptoms. Longer pain relief may be obtained at the cost of prolonged sensory deficits. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Debbie Y Dang
- Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID, USA
| | | | | | | | - Andrew T Stith
- Wyoming Orthopaedics and Sports Medicine, Cheyenne, WY, USA
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Nakasa T, Ikuta Y, Tsuyuguchi Y, Ota Y, Kanemitsu M, Adachi N. Application of a peripheral vein illumination device to reduce saphenous structure injury caused by screw insertion during arthroscopic ankle arthrodesis. J Orthop Sci 2019; 24:697-701. [PMID: 30630767 DOI: 10.1016/j.jos.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/15/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Arthroscopic ankle arthrodesis (AAA) is minimally invasive surgery, whereby percutaneous screw fixation is used through the medial aspect of the distal tibia to fusion the ankle, but it carries the risk of the saphenous vein and nerve injuries. The near-infrared (NIR) vascular imaging system, the VeinViewer® Flex, projects an image of the vein onto the skin, and the visualization of the vein may reduce the vein and nerve injuries. The purpose of this study is to investigate the risk of the saphenous vein injury by the percutaneous screw insertion during AAA, and to evaluate the effectiveness of the NIR vascular imaging system in the reduction of the saphenous vein injury. METHODS Ten patients with the ankle osteoarthritis underwent AAA. Three screw insertion sites (proximal as number 1, anterior distal as number 2, and posterior distal as number 3) were marked and then the vein was depicted on the medial malleolus using the VeinViewer® Flex. The distance between the screw insertion sites and the closest vein was measured. Additionally, the pattern of the vein course on the medial aspect of the distal tibia was investigated in 32 ankles using the VeinViewer® Flex. RESULTS The distance of number 1, 2, and 3 from the vein was 2.4 ± 1.4 mm (range from 0 to 5 mm), 6.3 ± 6.6 mm (range from 0 to 20 mm) and 3.5 ± 3.1 mm (range from 0 to 11 mm) respectively. In anterior screw insertion site, 3 of 10 cases showed just on the vein. The veins were observed at the anterior region from the center axis of the tibia more than 75% of ankles which was suspected as the greater saphenous vein with closely running of the saphenous nerve, but also other regions had the crossing vein. CONCLUSIONS Percutaneous screw fixation during AAA runs the risk of causing the saphenous structure injury. The NIR light imaging system is beneficial in reducing the complications of saphenous structure damage in AAA.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Yusuke Tsuyuguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
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Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2019; 44:rapm-2018-000019. [PMID: 30635506 DOI: 10.1136/rapm-2018-000019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.
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Affiliation(s)
- De Q Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, Swedish Medical Center, Seattle, Washington, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
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The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study. Reg Anesth Pain Med 2019; 43:474-479. [PMID: 29667940 DOI: 10.1097/aap.0000000000000764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Major ankle surgery causes intense postoperative pain, and whereas the importance of a sciatic nerve block is well established, the clinical significance of a supplemental saphenous nerve block has never been determined in a prospective, randomized, double-blind, placebo-controlled trial. We hypothesized that a saphenous nerve block reduces the proportion of patients experiencing significant clinical pain after major ankle surgery. METHODS Eighteen patients were enrolled and received a popliteal sciatic nerve block. Patients were randomized to single-injection saphenous nerve block with 10 mL 0.5% bupivacaine with 1:200,000 epinephrine or 10 mL saline (Fig. 1). Primary outcome was the proportion of patients reporting significant clinical pain, defined as a score greater than 3 on the numerical rating scale. Secondary outcomes were maximal pain and analgesia of the cutaneous territory of the infrapatellar branch of the saphenous nerve. RESULTS Eight of 9 patients in the placebo group reported significant clinical pain versus 1 of 9 patients in the bupivacaine-epinephrine group (P = 0.003). Maximal pain was significantly lower in the active compared with the placebo group (median, 0 [0-0] vs 5 [4-6]; P = 0.001). Breakthrough pain from the saphenous territory began within 30 minutes after surgery in all cases. Sensory testing of the cutaneous territory of the infrapatellar branch of the saphenous nerve showed correlation between pain reported in the anteromedial ankle region and the intensity of cutaneous sensory block in the anteromedial knee region. CONCLUSIONS The saphenous nerve is an important contributor to postoperative pain after major ankle surgery, with significant clinical pain appearing within 30 minutes after surgery. CLINICAL TRIALS REGISTRATION This study has been registered at ClinicalTrials.gov, identifier NCT02697955.
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Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study. Reg Anesth Pain Med 2018; 42:210-216. [PMID: 28033159 DOI: 10.1097/aap.0000000000000538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. METHODS Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. RESULTS The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. CONCLUSION Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.
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21
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How Will the Foot and Ankle Orthopedic Community Respond to the Growing Opioid Epidemic? FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418764463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In the midst of the current opioid crisis, it has become critically important to properly manage opioid-prescribing patterns for the treatment of postoperative pain. There is currently a scarcity of literature specifying prescription and consumption patterns following orthopedic surgery and specifically foot and ankle surgery. Clinical guidelines for postoperative pain management are deficient.
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Reb CW, Brandão RA, Watson BC, Van Dyke B, Berlet GC, Prissel MA. Medial Structure Injury During Suture Button Insertion Using the Center-Center Technique for Syndesmotic Stabilization. Foot Ankle Int 2018; 39:984-989. [PMID: 29641268 DOI: 10.1177/1071100718770200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The center-center technique for syndesmosis fixation has been described as an improved and reliable technique for proper reduction of the syndesmosis during ankle fracture repair. Concurrently, the use of flexible fixation with a suture button is becoming an established means of syndesmosis stabilization. The purpose of this cadaveric study was to assess for medial structure injury during the placement of a suture button using the center-center technique for ankle syndesmosis repair at 3 insertion intervals. METHODS Simulated open syndesmosis repair was performed on 10 cadaveric specimens. Three intervals were measured at 10 mm, 20 mm, and 30 mm proximal to the level of the distal tibial articular surface along the fibula. Proper longitudinal alignment of the center-center technique was completed under fluoroscopic guidance and was marked on the medial aspect of the tibia. The 3 intervals were drilled in the appropriate technique trajectory. The suture button was subsequently passed through each drill-hole interval. A single observer used a digital caliper to measure the distance from each suture button aperture with respect to the tibialis anterior tendon, tibialis posterior tendon, and greater saphenous vein and nerve. RESULTS A total of 30 interval measurements (10 cadavers with 3 suture button segments each) were used for data analysis. Direct impingement on the greater saphenous vein was seen in 11 of 30 (36.6%) interval measurements. Six of the 11 (54.5%) observed saphenous structure impingement events occurred at the 10-mm drill hole. CONCLUSION The results of the present study suggest that the use of the center-center technique for syndesmosis repair with suture button fixation risks preventable injury to the greater saphenous neurovasculature. CLINICAL RELEVANCE To understand the medial ankle anatomy, as it pertains to insertion of flexible syndesmotic fixation in a cadaveric model, to aid in prevention of clinical iatrogenic injury.
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Affiliation(s)
- Christopher W Reb
- 1 Foot and Ankle Division, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | | - Bryan Van Dyke
- 2 Orthopedic Foot and Ankle Center, Westerville, OH, USA
| | | | - Mark A Prissel
- 2 Orthopedic Foot and Ankle Center, Westerville, OH, USA
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Abstract
Postoperative pain is one of the most important factors in regard to patient outcomes. It has been linked with patient satisfaction, length of stay, and overall hospital costs. Peripheral nerve blocks have provided a safe, effective method to control early postoperative pain when symptoms are most severe. Peripheral nerve blocks, whether used intraoperatively or postoperatively, provide an alternative or adjunct to conventional pain management methods for patients who may not tolerate heavy narcotics or general anesthesia, in particular the elderly and those with cardiopulmonary disease.
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Affiliation(s)
- Tyler W Fraser
- Department of Orthopaedic Surgery, The University of Tennessee, Erlanger Health System, Chattanooga, TN, USA.
| | - Jesse F Doty
- Department of Orthopaedic Surgery, The University of Tennessee, Erlanger Health System, Chattanooga, TN, USA
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Rose B, Kunasingam K, Barton T, Walsh J, Fogarty K, Wines A. A Randomized Controlled Trial Assessing the Effect of a Continuous Subcutaneous Infusion of Local Anesthetic Following Elective Surgery to the Great Toe. Foot Ankle Spec 2017; 10:116-124. [PMID: 27613814 DOI: 10.1177/1938640016666923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Local anesthetic use for wound infusions, single injection, and continuous nerve blocks for postoperative analgesia is well established. No study has investigated the effect of a continuous block of the saphenous and superficial peroneal nerves at the level of the ankle joint following first ray surgery. A double blind randomized controlled trial was designed. One hundred patients with hallux valgus and rigidus requiring surgical correction were recruited and randomized to receive a postoperative continuous infusion at the ankle of normal saline or ropivacaine for 24 hours. Pain scores were recorded on postoperative days 1 and 7. There were more females than males. Follow-up was 100%. There were no significant differences in demographic data between the 2 randomized groups. There was no significant difference between the absolute visual analog scale scores on day 1 (P = .14) and day 7 (P = .16); nor was there a significant difference in reduction in scores between days 1 and 7 (P = .70). This study has shown no benefit to postoperative analgesia with the use of a continuous infusion of ropivacaine at the ankle. We, therefore, cannot currently recommend its use in the way described. Further studies may still identify a role for continuous local anesthetic infusions at the ankle to improve postoperative analgesia. LEVELS OF EVIDENCE Level I : Prospective randomised control trial.
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Affiliation(s)
- Barry Rose
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
| | - Kumar Kunasingam
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
| | - Tristan Barton
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
| | - James Walsh
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
| | - Karen Fogarty
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
| | - Andrew Wines
- Royal North Shore Hospital, Reserve Road, Sydney, New South Wales, Australia (BR, KK, TB, JW, KF, AW).,Royal United Hospital, Combe Park, Bath, United Kingdom (TB).,Cappagh National Orthopaedic Hospital, Finglas, Republic of Ireland (JW).,North Sydney Orthopaedic Sports Medicine, Sydney, New South Wales, Australia (AW)
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Effect of Nerve Stimulation Use on the Success Rate of Ultrasound-Guided Subsartorial Saphenous Nerve Block. Reg Anesth Pain Med 2017; 42:25-31. [DOI: 10.1097/aap.0000000000000522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pirozzi KM, Creech CL, Meyr AJ. Assessment of Anatomic Risk During Syndesmotic Stabilization With the Suture Button Technique. J Foot Ankle Surg 2015; 54:917-9. [PMID: 25940637 DOI: 10.1053/j.jfas.2015.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 02/03/2023]
Abstract
The suture button technique represents an accepted method of fixation for acute or chronic injury to the tibiofibular syndesmosis. The objective of the present investigation was to assess the anatomic risk to the superficial medial neurovascular structure with insertion of a syndesmotic suture button and to measure the distance of the button to the greater saphenous vein during a standardized insertion. A syndesmotic suture button was inserted with a standardized technique in 20 fresh frozen cadaveric limbs. Of 20 suture buttons, 14 (70.0%) were inserted posterior to the greater saphenous vein, 2 (10.0%) were inserted anterior to the greater saphenous vein, and 4 (20.0%) were inserted directly onto the greater saphenous vein. A total of 11 suture buttons (55.0%) were inserted with some entrapment of a medial neurovascular structure. The absolute mean ± standard deviation distance of the suture button to the greater saphenous vein was 4.88 ± 4.44 mm. The results of the present investigation have indicated that a risk of entrapment of superficial medial neurovascular structures exists with insertion of a suture button for syndesmotic fixation and that a medial incision should be used to ensure that structures are not entrapped.
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Affiliation(s)
| | - Corine L Creech
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Andrew J Meyr
- Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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Combined saphenous and sciatic catheters for analgesia after major ankle surgery: a double-blinded randomized controlled trial. Can J Anaesth 2015; 62:875-82. [DOI: 10.1007/s12630-015-0379-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 04/01/2015] [Indexed: 12/13/2022] Open
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Head SJ, Leung RC, Hackman GPT, Seib R, Rondi K, Schwarz SKW. Ultrasound-guided saphenous nerve block – within versus distal to the adductor canal: a proof-of-principle randomized trial. Can J Anaesth 2014; 62:37-44. [DOI: 10.1007/s12630-014-0255-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/14/2014] [Indexed: 11/24/2022] Open
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