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Garcia Tomas V, DeLeon AM, Johnson PA, Vargas K, MacLyman S, Chung B. Proximal Ultrasound-Guided Posterior Tibial Nerve Block for the Removal of Calcaneal Hardware. Cureus 2023; 15:e41047. [PMID: 37383303 PMCID: PMC10299757 DOI: 10.7759/cureus.41047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 06/30/2023] Open
Abstract
The anesthetic technique for calcaneal surgery has been reported to include peripheral nerve blocks, such as a sciatic block in the popliteal fossa, followed by intraoperative sedation. Sciatic nerve blocks are associated with limb weakness and fall risk. We present a case of a patient presenting for outpatient calcaneal surgery. The anesthetic plan consisted of a proximal, ultrasound-guided, single-injection selective posterior tibial nerve block followed by intraoperative sedation. The nerve block was performed, surgery concluded, and the patient received six hours of postoperative analgesia. Once the nerve block effects receded, the postoperative pain was managed with only over-the-counter analgesics while the patient was at home. We recommend an ultrasound-guided proximal posterior tibial nerve block for outpatient surgery involving the calcaneus to preserve lower extremity motor strength and provide postoperative analgesia.
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Affiliation(s)
- Vicente Garcia Tomas
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alexander M DeLeon
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Paul A Johnson
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Keziah Vargas
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Sarah MacLyman
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Brian Chung
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Su MP, Huang PJ, Tseng KY, Shen YC, Chen PN, Cheng KI. Pretreatment of ankle nerve block provides better postoperative analgesia than peri-incisional local anesthetic infiltration in hallux valgus correction surgery. Kaohsiung J Med Sci 2019; 35:168-174. [PMID: 30887717 DOI: 10.1002/kjm2.12029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/14/2018] [Indexed: 11/07/2022] Open
Abstract
Adequate postoperative analgesia after hallux valgus (HV) correction surgery improves early mobilization and decreases hospital stay. Peripheral nerve block and peri-incisional local anesthetic (LA) infiltration are both widely used for pain management in orthopedic surgeries. The aim of this study was to compare the analgesic effects between the ankle block and peri-incisional infiltration technique in patients undergoing HV correction surgery. Ninety patients scheduled for hallux valgus correction surgery were randomly allocated into three groups. In group N, patients were pretreated with tibial and peroneal nerve blocks with 8-10 mL of 0.25% bupivacaine before surgery. In group P, patients received the same LA for peri-incisional infiltration preoperatively. In group C, patients underwent surgery without regional analgesic pretreatment. All patients had intravenous fentanyl patient control analgesia as part of multimodal postoperative pain management. Fentanyl consumption, rest and moving pain scale, and adverse effects were evaluated at postoperative 6 h (Poh6), Poh12, Poh 24, and Poh36, respectively. Patients receiving bilateral feet surgeries were excluded in this study. Seventy-five patients were enrolled into final analysis. The patients in group N expressed lower resting and moving pain scores at Poh6, but the pain scores turned similarly among the three groups following Poh12 and then. The total fentanyl consumption was significantly less in group N than in group P. The postoperative activities and mood disturbance were not significantly different between groups after Poh12 and then. We conclude that ankle block is better than peri-incisional LA infiltration in HV correction surgery in pain relief and fentanyl consumption.
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Affiliation(s)
- Miao-Pei Su
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Chun Shen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Nien Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Delbos A, Philippe M, Clément C, Olivier R, Coppens S. Ultrasound-guided ankle block. History revisited. Best Pract Res Clin Anaesthesiol 2019; 33:79-93. [PMID: 31272656 DOI: 10.1016/j.bpa.2019.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Following forefoot surgery, compared to the traditional multimodal approach, regional anesthesia and analgesia provides high quality pain relief, decreases opioids consumption and leads to very high satisfaction scores. Traditional regional techniques relied either on wound infiltration, landmark technique ankle blocks or popliteal sciatic nerve block. Numerous anatomic variations of the different nerves might lead to failure following a blind technique. The current evolution towards ambulatory care will push surgical teams to favor techniques that simplify postoperative treatment and encourages immediate ambulation. The development of Ultrasound Guided Blocks has enabled us to perform very selective and precise nerve blocks. Ankle blocks provide excellent intraoperative anesthesia as well as long postoperative pain relief. Complications are rare using regional anesthesia for postoperative analgesia even after extensive foot surgery. Revival of ankle blocks is a perfect example of the high impact of new technological advances in improving ambulatory surgical care after foot surgery.
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Affiliation(s)
| | | | | | | | - Steve Coppens
- Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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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: 30] [Impact Index Per Article: 6.0] [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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Mittal R, Vermani E. Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature. Emerg Med J 2013; 31:143-7. [DOI: 10.1136/emermed-2012-201546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abdallah FW, Brull R. The Definition of Block “Success” in the Contemporary Literature. Reg Anesth Pain Med 2012; 37:545-53. [DOI: 10.1097/aap.0b013e3182583b00] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zamiri M, Wylie D, Munro CS. Peripheral nerve blockade for biopsy of plantar skin. Br J Dermatol 2010; 163:219-21. [PMID: 20346024 DOI: 10.1111/j.1365-2133.2010.09780.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Benzon HT, Sekhadia M, Benzon HA, Yaghmour E(T, Chekka K, Nader A. Ultrasound-Assisted and Evoked Motor Response Stimulation of the Deep Peroneal Nerve. Anesth Analg 2009; 109:2022-4. [DOI: 10.1213/ane.0b013e3181bc6ccd] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Soares LG, Brull R, Chan VW. Teaching an old block a new trick: ultrasound-guided posterior tibial nerve block. Acta Anaesthesiol Scand 2008; 52:446-7. [PMID: 18269399 DOI: 10.1111/j.1399-6576.2007.01515.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A review of approaches and techniques for lower extremity nerve blocks. Can J Anaesth 2007; 54:922-34. [DOI: 10.1007/bf03026798] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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