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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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Coviello A, Iacovazzo C, Cirillo D, Bernasconi A, Marra A, Squillacioti F, Martone M, Garone E, Coppola F, de Siena AU, Vargas M, Servillo G. Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study. Drug Des Devel Ther 2024; 18:1231-1245. [PMID: 38645991 PMCID: PMC11032716 DOI: 10.2147/dddt.s442808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Background and Aim Ultrasound popliteal sciatic nerve block (UPSNB) is commonly performed in foot and ankle surgery. This study aims to assess the use of dexmedetomidine and dexamethasone as adjuvants in UPSNB for hallux valgus (HV) surgery, comparing their efficacy in producing motor and sensory block and controlling postoperative pain. The adverse event rate was also evaluated. Methods This mono-centric retrospective study included 62 adult patients undergoing HV surgery: 30 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg and dexamethasone 4 mg (Group 1), whereas 32 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg, and dexmedetomidine 1 mcg/Kg (Group 2). At first, the visual analogue scale (VAS) was evaluated after 48 hours. The other outcomes were time to motor block regression, evaluation of the first analgesic drug intake, analgesic effect, adverse effects (hemodynamic disorders, postoperative nausea and vomiting (PONV)) and patient satisfaction. The continuous data were analyzed with student's t-test and the continuous one with χ2. Statistical significance was set at a p-value lower than 0.05. Results No significant difference was found in VAS after 48 hours (4.5 ± 1.6 vs 4.7 ± 1.7, p = 0.621) to motor block regression (18.9 ± 6.0 vs 18.7 ± 6, p = 0.922). The number of patients that took their first analgesic drug in the first 48 h (p = 0.947 at 6 hours; p = 0.421 at 12 hours; p = 0.122 at 24 hours and p = 0.333 at 48 hours) were not significant. A low and similar incidence of intraoperative hemodynamic disorders was recorded in both groups (hypotension p = 0.593; bradycardia p = 0.881). Neither PONV nor other complication was found. Patients in Group 1 reported a lower degree of interference with sleep (p = 0.001), less interference with daily activities (P = 0.002) and with the affective sphere (P = 0.015) along with a more satisfactory postoperative pain management (p < 0.001) as compared to Group 2. Conclusion No significant differences were observed in the duration of motor and sensory blockade between patients in both groups. Additionally, both groups showed good pain control with a low rate of adverse effects, even if there was no clinical difference between the groups. However, patients who received dexamethasone reported experiencing less interference with their sleep, daily activities and overall emotional well-being, and overall pain control.
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Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Alessio Bernasconi
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Francesco Squillacioti
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Marco Martone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Eleonora Garone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Filomena Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Andrea Uriel de Siena
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80131, Italy
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Mayich DJ. Wide-Awake Local Anesthetic No Tourniquet Surgery of the Foot and Ankle. Orthop Clin North Am 2023; 54:471-483. [PMID: 37718086 DOI: 10.1016/j.ocl.2023.05.003] [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: 09/19/2023]
Abstract
Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This has been documented with significant and growing body of literature. WALANT could offer significant advantages with respect to patient experience, per case cost of procedures as well as for improving access for patients to operative resources in a setting of scarcity or restricted access.
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Affiliation(s)
- D Joshua Mayich
- Stanton Territorial Hospital, 548 Byrne Road, Yellowknife, NT, Canada.
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Bakaes Y, Gonzalez T, Jackson JB. Effect of Supplemental Regional Anesthesia on the Complication and Readmission Rate of Patients After Elective Foot and Ankle Surgery. Foot Ankle Spec 2023:19386400231181280. [PMID: 37421261 DOI: 10.1177/19386400231181280] [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: 07/10/2023]
Abstract
BACKGROUND The purpose of this study is to define the effect of facility type (inpatient vs outpatient) for the use of supplemental regional anesthesia (SRA), and SRA's effect on complications, readmissions, operation time, and length of hospital stay after elective foot and ankle surgery. METHODS We performed a retrospective review to identify a large cohort of adult patients who underwent elective foot and ankle surgery between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program database. We fit log-binomial generalized linear models to estimate risk ratios for general anesthesia (GA) with SRA versus GA alone, and linear regression models to estimate the effect of GA with SRA on the average total hospital length of stay (in days) and operation time (in minutes); we also performed inverse propensity scores. RESULTS We found that there is no statistical difference in the rate of readmissions (P = .081) between patients under GA alone versus GA with SRA. In the propensity score analysis, patients who underwent midfoot/forefoot surgery had 3.85 times the risk of complications under GA with SRA compared with GA alone (P = .045). Also, patients who received GA with SRA had a longer unadjusted operative duration (102.22 minutes) when compared with patients who received GA alone (93.84 minutes) (P < .001). However, patients who received GA alone had a longer unadjusted hospital length of stay (0.88 days) when compared with patients who received GA with SRA (0.70 days) (P = .006). CONCLUSION This study found that, when compared with GA alone, GA with SRA leads to a statistically significant increased operative time but a shorter hospital stay without significantly increasing readmissions and only increasing the risk of complications for midfoot/forefoot surgery within 30 days postoperatively for elective foot and ankle surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yianni Bakaes
- School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Tyler Gonzalez
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
| | - J Benjamin Jackson
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
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Moosa F, Allan A, Bedforth N. Regional anaesthesia for foot and ankle surgery. BJA Educ 2022; 22:424-431. [PMID: 36304911 PMCID: PMC9596281 DOI: 10.1016/j.bjae.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- F. Moosa
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A. Allan
- Great Western Hospital Foundation Trust, Swindon, UK
| | - N. Bedforth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Chen FR, Quan T, Manzi JE, Gu A, Wei C, Tabaie S, Chodos M, Chapman CB, Pryor KO, Liu J. Evaluating the Association between Anesthesia Type and Postoperative Complications for Patients Receiving Total Ankle Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:113-119. [PMID: 35821927 PMCID: PMC9210406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is performed for ankle arthritis and there has been interest investigating which anesthetic method is the best choice in order to optimize perioperative outcomes. In this study, we compared postoperative complications after TAA for patients receiving either 1) general anesthesia alone or 2) general anesthesia plus regional anesthesia. METHODS Patients undergoing primary TAA from 2007 to 2018 were identified in a national database. Patients were stratified into 2 cohorts: general anesthesia and general anesthesia combined with regional anesthesia. In this analysis, 30-day wound, cardiac, pulmonary, renal, thromboembolic, and sepsis complications, as well mortality, postoperative transfusion, urinary tract infection, extended length of stay, and reoperation were assessed. Bivariate analyses and multivariable logistical regression were performed. RESULTS Of 1,084 total patients undergoing TAA, 878 patients (81.0%) had general anesthesia and 206 (19.0%) had general anesthesia combined with regional anesthesia. Following adjustment, there were no increased risk of postoperative complications in the combined general and regional anesthesia group compared to those who only underwent general anesthesia. CONCLUSION Compared to general anesthesia alone, the addition of regional anesthesia to general anesthesia for TAA is not associated with increased risk of complications in the perioperative period. Level of Evidence: III.
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Affiliation(s)
- Frank R. Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennysylvania, USA
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children’s National Health System, Washington, DC, USA
| | - Marc Chodos
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Cary B. Chapman
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, Florida, USA
| | - Kane O. Pryor
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
- Department of Regional Anesthesia and Acute Pain Management, Hospital for Special Surgery, New York, New York, 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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Biz C, de Iudicibus G, Belluzzi E, Dalmau-Pastor M, Bragazzi NL, Funes M, Parise GM, Ruggieri P. Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks. BMC Musculoskelet Disord 2021; 22:1043. [PMID: 34911525 PMCID: PMC8675526 DOI: 10.1186/s12891-021-04911-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.
| | - Gianfranco de Iudicibus
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy. .,Musculoskeletal Pathology and Oncology Laboratory, Orthopaedics and Orthopedics Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 3518, Padova, Italy.
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.,Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Manuela Funes
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Gian-Mario Parise
- Institute of Anesthesia and Reanimation, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 3, 35128, Padova, Italy
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Kang C, Hwang DS, Song JH, Lee GS, Lee JK, Hwang SJ, Jeon JH, An BK. Clinical analyses of ultrasound-guided nerve block in lower-extremity surgery: A retrospective study. J Orthop Surg (Hong Kong) 2021; 29:2309499021989102. [PMID: 33626984 DOI: 10.1177/2309499021989102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the clinical effects and results of lower-extremity surgery under ultrasound-guided nerve block; time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, visual analog scale (VAS) satisfaction score, and anesthetic-related complications. METHODS A total of 3312 cases (2597 patients) from January 2010 to April 2015 were analyzed retrospectively. A senior author performed ultrasound-guided nerve block of the lateral femoral cutaneous nerve (LFCN, 630 cases), femoral nerve (FN, 2503 cases), obturator nerve (ON, 366 cases), sciatic nerve (SN, 3271 cases), or posterior femoral cutaneous nerve (PFCN, 222 cases) depending on the type of surgery. Time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, VAS satisfaction score, and anesthetic-related complications were analyzed. RESULTS The mean times required were 1.1 min for SN block, 2.5 min for FN/SN block (1762 cases), and 4.8 min for FN/SN/LFCN/ON block. The mean anesthesia onset time was 48 min. The mean durations of anesthesia were 4.5 h for FN dermatome and 5.6 h for SN dermatome. The mean duration of analgesia was 11.5 h. The mean tolerable tourniquet times after were 35, 51, and 84 min after SN block, FN/SN block, and FN/SN/LFCN/ON block, respectively. The mean VAS satisfaction score was 9.3. There were no anesthetic-related complications, such as infection, hematoma, paralysis, or nerve irritation. CONCLUSION Selective block of the LFCN, FN, ON, SN, and PFCN based on the locations of lesions and type of surgery showed favorable clinical results with high efficacy. Ultrasound-guided nerve block may be a good option for anesthesia and analgesia in lower-extremity surgery.
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Affiliation(s)
- Chan Kang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Deuk-Soo Hwang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jae-Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, South Korea
| | - Gi-Soo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jeong-Kil Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung-Jin Hwang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Je-Hyung Jeon
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Byung-Kuk An
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Kim BS, Kim K, Day J, Seilern Und Aspang J, Kim J. Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105059. [PMID: 34064708 PMCID: PMC8151049 DOI: 10.3390/ijerph18105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Beom Suk Kim
- Uijeongbu Eulji Medical Center, Department of Physical Medicine and Rehabilitation, Eulji University, Daejeon 11759, Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyungho Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Samsung Medical Center, Department of Orthopedic Surgery, Seoul 06351, Korea
| | - Jonathan Day
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Jesse Seilern Und Aspang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jaeyoung Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Correspondence:
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Pool KH, Burton BN, Beletsky A, Finneran JJ, Gabriel RA. Monitored Anesthesia Care Versus General Anesthesia as the Primary Anesthetic for Ankle Amputations. J Cardiothorac Vasc Anesth 2021; 35:3283-3287. [PMID: 33637421 DOI: 10.1053/j.jvca.2021.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The authors hypothesized that monitored anesthesia care (MAC)-either by local sedation or regional anesthesia (RA)-compared with general anesthesia (GA), would be associated with lower odds of significant 30-day postoperative complications and mortality in patients undergoing an ankle amputation. DESIGN Retrospective cohort study. SETTING Inpatient. PARTICIPANTS The authors used data from patients who underwent ankle amputation from the American College of Surgeons National Surgical Quality Improvement Program registry. INTERVENTION RA as primary anesthetic. MEASUREMENTS AND MAIN RESULTS A multivariate logistic regression was used to evaluate the association of primary anesthesia type with the outcomes. The regression analysis included all covariates to test the association of the primary exposure variable (anesthesia type) with each outcome of interest. The odds ratio (OR), with associated 95% confidence interval (CI), was reported for each covariate. There were a total of 3,368 patients undergoing guillotine amputation through the tibia/fibula (n = 2,935) or ankle disarticulation (n = 433). Among these patients, 15.5% (n = 491) received MAC as their primary anesthetic. Among all patients, 11.4% (n = 363) experienced a significant postoperative complication. On multivariate logistic regression, MAC was found to decrease odds of postoperative complications (OR 0.57, 95% CI 0.40-0.82, p = 0.002), but not mortality (OR 1.26, 95% CI 0.87-1.84, p = 0.22). CONCLUSION This study showed that MAC was associated with improved outcomes, as opposed to GA, as the primary anesthetic in ankle amputations.
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Affiliation(s)
- Kate H Pool
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA
| | - Brittany N Burton
- School of Medicine, University of California, San Diego, La Jolla, CA
| | | | - John J Finneran
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA; Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA.
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Local Infiltration Analgesia with Ropivacaine Improves Postoperative Pain Control in Ankle Fracture Patients: A Retrospective Cohort Study. Pain Res Manag 2020; 2020:8542849. [PMID: 32215137 PMCID: PMC7085379 DOI: 10.1155/2020/8542849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/13/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Purpose The study aimed at investigating the effect of local infiltration analgesia (LIA) with ropivacaine on postoperative analgesia for patients undergoing ankle fracture surgery. Methods Consecutive patients were retrospectively included and analysed according to their medical records from July 2014 to August 2018 in a tertiary hospital. Inclusion criteria were patients undergoing open reduction and internal fixation (ORIF) for ankle fractures under general anaesthesia. Moreover, patients should have received intravenous patient-controlled analgesia (iPCA) or LIA + iPCA for postoperative pain relief. The primary outcome indicator was visual analogue scale (VAS) from 8 hours to 48 hours after surgery. Secondary outcomes included postoperative opioid requirement, need for rescue medication, opioid-related adverse effects, and wound complications. Results In total, 89 consecutive patients were included in the study. There were 48 males and 41 females. The average age was 44.6 ± 7.0 years, and VAS scores were significantly lower in the LIA + iPCA group at 8 hours after surgery (1.51 ± 0.58 cm vs 4.77 ± 1.83 cm, p < 0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p < 0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p < 0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p < 0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p < 0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, Conclusions The retrospective cohort study indicates that LIA with ropivacaine can provide better early postoperative pain management with a reduction of VAS scores for ankle fracture surgery. Patients receiving wound infiltration also experience decreased opioid consumption, a lower rate of analgesia-related side effects, and comparable wound complication rate.
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Abstract
Anesthesia management during hallux valgus surgery trends toward multimodal pain control. Locoregional anesthesia with peripheral nerve blocks and wound instillation increase pain control. Peripheral nerve blocks as first-line analgesia are effective with minimal side effects. Local wound instillation has a variable but positive effect with minimal negative side effects. Nonsteroidal anti-inflammatory drugs in bone-to-bone healing remain controversial; however, they reduce opiate requirements and enhance patient satisfaction. Opiate agonists remain the mainstay for postoperative pain; long-acting formulations minimize pain crises. Multimodal analgesia with locoregional anesthesia facilitate the progress of hallux valgus surgery as an outpatient procedure.
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Affiliation(s)
- Max Seiter
- Sports Medicine Orthopaedic Surgery, Steadman Philippon Research Institute, 181 W Meadow Dr., Vail, CO 81657, USA
| | - Amiethab Aiyer
- Orthopaedic Surgery, University of Miami, Jackson Memorial Hospital, 900 NW 17th Street, Miami, FL 33136, USA.
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Jain SK, Dar MY, Kumar S, Yadav A, Kearns SR. Role of anti-oxidant (vitamin-C) in post-operative pain relief in foot and ankle trauma surgery: A prospective randomized trial. Foot Ankle Surg 2019; 25:542-545. [PMID: 30321947 DOI: 10.1016/j.fas.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/10/2018] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Post-operative pain may adversely affect a patient's quality of life. Studies have shown that vitamin C, being an anti-oxidant and neuro-modulating agent, can help to reduce pain in a variety of clinical settings. The objective of this randomized controlled trial was to assess the effectiveness of vitamin C in reducing post-operative pain, analgesia requirements and improving functional outcome. METHODS Patients with isolated foot and ankle trauma, who had undergone surgery, were randomly assigned to receive either vitamin C 500mg or a placebo tablet twice a day. VAS score, analgesia requirement and functional outcome were assessed during their regular follow up. Results were compared and analyzed at the end of 3 months. RESULTS The group which received vitamin C, showed improvement in VAS score at the end of second and sixth week of follow up, reduced analgesia requirements and improved functional outcome as compared to the placebo group. CONCLUSIONS This study shows that the supplementation of vitamin C in patients undergoing surgery for foot and ankle trauma helps to reduce analgesic requirements, improve VAS scores and achieve better functional outcome.
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Affiliation(s)
- Sumit Kumar Jain
- Department of Orthopaedics, NDMC Medical College & Hindu Rao Hospital, Delhi, 110007, India.
| | - Mohammad Yahya Dar
- Department of Orthopaedics, NDMC Medical College & Hindu Rao Hospital, Delhi, 110007, India.
| | - Sanjeev Kumar
- Department of Orthopaedics, NDMC Medical College & Hindu Rao Hospital, Delhi, 110007, India.
| | - Arun Yadav
- Department of Orthopaedics, NDMC Medical College & Hindu Rao Hospital, Delhi, 110007, India.
| | - Stephen R Kearns
- Department of Orthopaedics, Galway University Hospitals, Galway, Ireland.
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15
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Taylor MA, Parekh SG. Optimizing Outpatient Total Ankle Replacement from Clinic to Pain Management. Orthop Clin North Am 2018; 49:541-551. [PMID: 30224015 DOI: 10.1016/j.ocl.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient total ankle arthroplasty is a potential significant source of cost savings. The ability to institute an effective outpatient total ankle program depends on appropriate patient selection, surgeon experience with total ankle replacement, addressing preoperative patient expectations, the involvement of an experienced multidisciplinary care team including experienced anesthesiologists, nurse navigators, recovery room nursing staff and physical therapists, and most importantly, such a program requires complete institutional logistical support.
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Affiliation(s)
- Michel A Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Fuqua School of Business, 100 Fuqua Drive, Durham, NC 27708, USA; North Carolina Orthopedic Clinic, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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16
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Park YU, Cho JH, Lee DH, Choi WS, Lee HD, Kim KS. Complications After Multiple-Site Peripheral Nerve Blocks for Foot and Ankle Surgery Compared With Popliteal Sciatic Nerve Block Alone. Foot Ankle Int 2018; 39:731-735. [PMID: 29366344 DOI: 10.1177/1071100717753954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Single or combined multiple-site peripheral nerve blocks (PNBs) are becoming popular for patients undergoing surgery on their feet or ankles. These procedures are known to be generally safe in surgical settings compared with other forms of anesthesia, such as spinal block. The purposes of this study were to assess the incidence of complications after the administration of multiple PNBs for foot and ankle surgery and to compare the rates of complications between patients who received a single PNB and those who received multiple blocks. METHODS Charts were reviewed retrospectively to assess peri- and postoperative complications possibly related to the PNBs. The records of 827 patients who had received sciatic nerve blocks, femoral nerve blocks adductor canal blocks, or combinations of these for foot and/or ankle surgery were analyzed for complications. The collected data consisted of age, sex, body mass index, presence of diabetes mellitus, smoking history, tourniquet time, and complications both immediately postoperatively and 1 year later. RESULTS Of these 827 patients, 92 (11.1%) developed neurologic symptoms after surgery; 22 (2.7%) of these likely resulted from the nerve blocks, and 7 (0.8%) of these were unresolved after the patients' last follow-up visits. There were no differences in complication rates between combined blocks and single sciatic nerve blocks. CONCLUSION There were more complications, both transient and long term, after anesthetic PNBs than previous literature has reported. Combined multiple-site blocks did not increase the rate of neurologic complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Uk Park
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Jae Ho Cho
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Doo Hyung Lee
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Wan Sun Choi
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Han Dong Lee
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Keun Soo Kim
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
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Jarrell K, McDonald E, Shakked R, Nicholson K, Kasper V, Raikin SM. Combined Popliteal Catheter With Single-Injection vs Continuous-Infusion Saphenous Nerve Block for Foot and Ankle Surgery. Foot Ankle Int 2018; 39:332-337. [PMID: 29254445 DOI: 10.1177/1071100717744331] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The increasing scope and complexity of foot and ankle procedures performed in an outpatient setting require more intensive perioperative analgesia. Regional anesthesia (popliteal and saphenous nerve blocks) has been proven to provide satisfactory pain management, decreased postoperative opioid use, and earlier patient discharge. This can be further augmented with the placement of a continuous-flow catheter, typically inserted into the popliteal nerve region. This study investigated the use of a combined popliteal and saphenous continuous-flow catheter nerve block compared to a single popliteal catheter and single-injection saphenous nerve block in postoperative pain management after ambulatory foot and ankle surgery. METHODS A prospective study was conducted using 60 patients who underwent foot and ankle surgery performed in an outpatient setting. Demographic data, degree of medial operative involvement, American Society of Anesthesiologists physical classification system, anesthesia time, and postanesthesia care unit time were recorded. Outcome measures included pain satisfaction, numeric pain scores (NPS) at rest and with activity, and opioid intake. Patients were also classified by degree of saphenous nerve involvement in the operative procedure, by the surgeon who was blinded to the anesthesia randomization. RESULTS Patients in the dual-catheter group took significantly less opioid medication on the day of surgery and postoperative day 1 (POD 1) compared to the single-catheter group ( P = .02). The dual-catheter group reported significantly greater satisfaction with pain at POD 1 and POD 3 and a significantly lower NPS at POD 1, 2, and 3. This trend was observed in all 3 subgroups of medial operative involvement. CONCLUSION Patients in the single-catheter group reported more pain, less satisfaction with pain control, and increased opioid use on POD 1, suggesting dual-catheter use was superior to single-injection nerve blocks with regard to managing early postoperative pain in outpatient foot and ankle surgery. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Kathleen Jarrell
- 1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth McDonald
- 2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rachel Shakked
- 2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kristen Nicholson
- 2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Steven M Raikin
- 2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Gupta A, Kumar K, Roberts MM, Sanders AE, Jones MT, Levine DS, O'Malley MJ, Drakos MC, Elliott AJ, Deland JT, Ellis SJ. Pain Management After Outpatient Foot and Ankle Surgery. Foot Ankle Int 2018; 39:149-154. [PMID: 29078056 DOI: 10.1177/1071100717738495] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia. METHODS Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids. RESULTS Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication. CONCLUSIONS Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Akash Gupta
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kanupriya Kumar
- 2 Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Matthew M Roberts
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Austin E Sanders
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mackenzie T Jones
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David S Levine
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Martin J O'Malley
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mark C Drakos
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew J Elliott
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Loveday DT, Barr LV, Loizou CL, Barton G, Smith G. A comparative prospective cohort health economic analysis comparing ankle fusion, isolated great toe fusion and hallux valgus surgery. Foot Ankle Surg 2018; 24:54-59. [PMID: 29413775 DOI: 10.1016/j.fas.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/27/2016] [Accepted: 11/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the health economics and outcomes of three common foot and ankle operations. METHODS Between July 2013 and October 2014 all patients undergoing ankle fusion (AF) for osteoarthritis, first metatarsophalangeal joint fusion for osteoarthritis (MF) or hallux valgus surgery (HV) were included. Patients having additional procedures were excluded. Patients completed the Manchester-Oxford Foot Questionnaire (MOX-FQ), the EuroQol EQ-5D-5L questionnaire and the EQ-VAS on presentation and at least 6 months post-operatively. RESULTS 63 patients undergoing AF (n=22), MF (n=22), or HV (n=32) completed preoperative and postoperative questionnaires. 76 completed preoperative questionnaires and 63 completed the follow up questionnaires. The follow up questionnaires were completed at a median of 12 months (range 6-24 months) following surgery. The mean age at surgery was 59 years (range 26-85 years). Pre-operative MOX-FQ and EQ-5D-5L scores differed significantly between the three groups with AF and MF patients reporting worse scores compared to HV patients. MOX-FQ and EQ-5D-5L significantly improved in all groups from pre-operative levels. MOX-FQ AF from 53.8 (CI 56.8-50.8) to 22.9 (CI 30.9-14.9), MF from 43.0 (CI 46.4-39.6) to 12.1 (CI 18.3-5.9), HV from 35.4 (CI 39.0-31.7) to 15.6 (CI 21.1-10.1). EQ-5D-5L: AF from 0.30 (CI 0.43-0.17) to 0.66 (CI 0.77-0.55), MF from 0.45(CI 0.52-0.38) to 0.83 (CI 0.90-0.76), HV from 0.71(CI 0.74-0.68) to 0.82 (CI 0.88-0.76). There was no significant difference in the EQ-VAS suggesting it may not be representative of foot and ankle health. Health economics analysis using the EQ-5D-5L data to estimate quality-adjusted life years (QALYs) suggested all three procedures were favourable compared to threshold levels of cost-effectiveness. There were differences in estimated costs between the three operations with AF at £2950 (threshold cost <£5400) and MF at £1197 (threshold cost <£5780) and HV varying from £625 to £1688 (threshold cost <£1640). CONCLUSIONS This study reveals that the joint-specific (MOX-FQ) and generic health (EQ-5D-5L) outcome scores of patients improved after AF, MF and HV. The greatest benefit from surgery was gained in the arthritic patient groups. In the future, the use of large population patient reported outcome measures data may also potentially have implications for prioritisation of healthcare provision, acting as an indicator of foot and ankle surgical procedures that produce the most benefit to patients.
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Affiliation(s)
- David T Loveday
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Lynne V Barr
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | | | - Garry Barton
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - George Smith
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
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20
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Enomoto M, Lascelles BDX, Gerard MP. Defining local nerve blocks for feline distal pelvic limb surgery: a cadaveric study. J Feline Med Surg 2017; 19:1215-1223. [PMID: 28186424 PMCID: PMC11104168 DOI: 10.1177/1098612x17690652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives Anatomical and methodological detail is lacking regarding local anesthetic peripheral nerve block techniques for distal pelvic limb surgery in cats. The aim of this study was to develop, describe and test nerve block methods based on cadaveric dissections and dye injections. Methods Ten pairs of feline pelvic limbs (n = 20) were dissected and the tibial nerve (T n.), common fibular (peroneal) nerve (CF n., and its two branches, the superficial fibular [peroneal] nerve [SpF n.] and the deep fibular [peroneal] nerve [DpF n.]) and the saphenous nerve (Sa n.) were identified. Based on these dissections, a 'distal crus block' (selective blockade of the CF n., T n. and Sa n.) and a 'distal pes block' (selective blockade of the SpF n., DpF n., T n. and Sa n.) were developed for surgical procedures in two different regions of the distal pelvic limb. Techniques were tested using new methylene blue (NMB) dye injections in feline pelvic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.1 ml/kg of NMB dye solution was injected at the site of the CF n., and 0.05 ml/kg was injected at the sites of the SpF n., DpF n., Sa n. and T n. The length and circumference (fully or partially stained) of each stained nerve were measured. Results Positive staining of nerves was observed in 12/12 limbs. The lengths stained for the CF n., DpF n., SpF n., Sa n. and T n. were 27.19 ± 7.13, 20.39 ± 5.57, 22.82 ± 7.13, 30.89 ± 6.99 and 25.16 ± 8.09 mm, respectively. The nerves were fully stained in 12, 12, 10, 11 and 11 out of 12 limbs, respectively. Conclusions and relevance These two, three-point injection methods may be an effective perioperative analgesia technique for feline distal pelvic limb procedures.
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Affiliation(s)
- Masataka Enomoto
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - B Duncan X Lascelles
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
- Center for Pain Research and Innovation, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA
- Center for Translational Pain Research, Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Mathew P Gerard
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 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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Joe HB, Choo HS, Yoon JS, Oh SE, Cho JH, Park YU. Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery: A prospective, randomized noninferiority trial. Medicine (Baltimore) 2016; 95:e5758. [PMID: 28033291 PMCID: PMC5207587 DOI: 10.1097/md.0000000000005758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A femoral nerve block (FNB) in combination with a sciatic nerve block (SNB) is commonly used for anesthesia and analgesia in patients undergoing hindfoot and ankle surgery. The effects of FNB on motor function, related fall risk, and rehabilitation are controversial. An adductor canal block (ACB) potentially spares motor fibers in the femoral nerve, but the comparative effect on hindfoot and ankle surgeries between the 2 approaches is not yet well defined. We hypothesized that compared to FNB, ACB would cause less weakness in the quadriceps and produce similar pain scores during and after the operation. METHODS Sixty patients scheduled for hindfoot and ankle surgeries (arthroscopy, Achilles tendon surgery, or medial ankle surgery) were stratified randomized for each surgery to receive an FNB (FNB group) or an ACB (ACB group) combined with an SNB. The primary outcome was the visual analog scale (VAS) pain score at each stage. Secondary outcomes included quadriceps strength, time profiles (duration of the block procedure, time to full anesthesia and time to full recovery), patients' analgesic requirements, satisfaction, and complications related to peripheral nerve blocks such as falls, neurologic symptoms, and local anesthetic systemic toxicity were evaluated. The primary outcome was tested for the noninferiority of ACB to FNB, and the other outcomes were tested for the superiority of each variable between the groups. RESULTS A total of 31 patients received an ACB and 29 received an FNB. The VAS pain scores of the ACB group were not inferior during and after the operation compared to those of the FNB group. At 30 minutes and 2 hours after anesthesia, patients who received an ACB had significantly higher average dynamometer readings than those who received a FNB (34.2 ± 20.4 and 30.4 ± 23.7 vs 1.7 ± 3.7 and 2.3 ± 7.4, respectively), and the results were similar at 24 and 48 hours after anesthesia. There were no differences between the 2 groups with regard to time profiles and patient satisfaction. No complications were noted. CONCLUSION ACB preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain. Therefore, ACB may be a good alternative to FNB for reducing the potential fall risk.
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Affiliation(s)
- Han Bum Joe
- Department of Anesthesiology and Pain Medicine
| | - Ho Sik Choo
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Sang Yoon
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Eon Oh
- Department of Anesthesiology and Pain Medicine
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Graves NC, Rettedal DD, Marshall JJ, Frush K, Vardaxis V. Ultrasound assessment of dorsal lisfranc ligament strain under clinically relevant loads. J Am Podiatr Med Assoc 2016; 104:11-8. [PMID: 24504571 DOI: 10.7547/0003-0538-104.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound. METHODS Randomized ultrasound imaging trials were performed on 50 asymptomatic feet of 20-to-32-year-old individuals who were free of lower-extremity abnormalities. The dorsal Lisfranc ligament was ultrasound imaged under low, medium, and high stress while at 0° and 15° abducted foot orientations. Load was applied using a seated calf-raise apparatus, and a single examiner performed all of the tests. Two-way repeated-measures analysis of variance was used to determine any significant load or position main effects or load × position interaction. RESULTS Position main effect for dorsal Lisfranc ligament length demonstrated a significant overall increase in ligament length of 0.21 mm (P < .001), which reflects a 4.03% change in ligament length between the rectus and 15° abducted orientations. Furthermore, low and medium loads demonstrated significant length increase with position effect (P = .03 and P < .001, respectively). No significant load main effect or interaction was determined. CONCLUSIONS Dorsal Lisfranc ligament length undergoes more strain in an abducted foot position at the same load compared with in a rectus foot. We advocate measuring under a medium load if possible and comparing foot positions for the maximum length changes. The participant stress loads and foot positions used are clinically feasible, which makes it possible to perform this ultrasound procedure in the clinical setting.
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Affiliation(s)
- Nathan C Graves
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA. Dr. Graves is now with the Department of Orthopedic Surgery and Rehabilitation, Division of Foot and Ankle, University of Florida at Jacksonville, Jacksonville, FL
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Ryba D, Ibrahim N, Choi J, Vardaxis V. Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging. Foot (Edinb) 2016; 26:30-5. [PMID: 26802947 DOI: 10.1016/j.foot.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/20/2015] [Accepted: 10/29/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Research findings have linked dorsal Lisfranc ligament (dLL) rupture to complete Lisfranc ligament complex rupture; identifying deformation characteristics of the dorsal Lisfranc ligament alone may be helpful in diagnosing complete ligament rupture. The goal of the present study was to assess the deformation characteristics of the asymptomatic dLL using physiologically relevant stress/loads in a clinical setting and to discern normative dLL parameters. METHODS Unilateral dLL measurements were taken from 50 healthy volunteers, using sonographic imaging under three different stress/load conditions. Stress/load was applied using the individuals' bodyweight (low-seated; medium-bilaterally equal weight bearing in standing; and high-single leg standing). Digital images of the dLL captured using ultrasound were visualized to determine the dLL length. One-way repeated measures ANOVA was used to assess changes in the dLL length with load. RESULTS The average dLL elongation, as percent resting length change, was 8.76% between seated and single leg standing positions. Most of the dLL elongation (6.26%) occurred between seated and bilateral standing. CONCLUSIONS The deformation and role of the dorsal Lisfranc ligament can be observed using sonographic imaging resulting from physiological loading in the clinical setting. CLINICAL RELEVANCE These deformation parameters can be used to generate normative data for diagnostic purposes.
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Affiliation(s)
- Dalton Ryba
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States
| | - Nooreen Ibrahim
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States
| | - Jim Choi
- Iowa Radiology PC, West Des Moines, IA, United States
| | - Vassilios Vardaxis
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA, United States; Department of Physical Therapy, Des Moines University, Des Moines, IA, United States.
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Gruetter F, Rudkin G, Stavrou P, Dracopoulos G, Jakob M, Iselin LD. Use of peripheral blocks and tourniquets in foot surgery: A survey of Australian orthopaedic foot and ankle surgeons. Foot Ankle Surg 2015; 21:282-5. [PMID: 26564732 DOI: 10.1016/j.fas.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/09/2014] [Accepted: 03/04/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The most common reasons for unplanned admission to the hospital from outpatient surgery have the potential to be minimised or eliminated by peripheral nerve blocks (PNB). Tourniquets are commonly used in elective extremity surgery but it's use is mostly guided by personal preferences and does no correlate with the existing literature. Our aim was to explore the current practice of PNB and tourniquet use by foot and ankle surgeons in Australia. METHODS The Australian Orthopaedic Foot and Ankle Surgery Society (AOFAS) annual meeting was held in Adelaide in 2011. Members were asked to complete an electronic survey on their current use of peripheral nerve blocks and tourniquets. Two specific elective case scenarios were included for comment, one pertaining to forefoot pathology, the other hindfoot pathology. RESULTS Twenty-three AOFAS members replied to the survey, an overall response rate of 76.6%. Of these, only two surgeons did not use ankle blocks in elective surgery and none were prepared to operate without a tourniquet. Most Australian foot and ankle surgeons were reluctant to use local anaesthetic techniques without an accompanying GA. CONCLUSIONS While the literature suggests that GA may add to complications without any benefit for the procedure and that distally based tourniquets may add benefit, these are not the favoured techniques in Australian foot and ankle surgeons.
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Affiliation(s)
| | - Glenda Rudkin
- Specialist Anaesthetic Services, Adelaide, SA, Australia
| | - Peter Stavrou
- Adelaide Orthosports Clinic, Adelaide, SA, Australia
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Girón-Arango L, Vásquez-Sadder MI, González-Obregón MP, Gamero-Fajardo CE. Bloqueo de tobillo guiado por ultrasonido: una técnica anestésica atractiva para cirugía de pie. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Girón-Arango L, Vásquez-Sadder MI, González-Obregón MP, Gamero-Fajardo CE. Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vadivelu N, Kai AM, Maslin B, Kodumudi V, Antony S, Blume P. Role of regional anesthesia in foot and ankle surgery. Foot Ankle Spec 2015; 8:212-9. [PMID: 25655517 DOI: 10.1177/1938640015569769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Regional anesthesia has increasingly expanded its role in the perioperative care of patients undergoing foot and ankle surgery. In addition to avoiding side effects associated with both general anesthesia and neuraxial anesthetic techniques, especially those related to cardiovascular and pulmonary systems, regional nerve blocks have been shown to improve postoperative pain and reduce hospital stay and associated expenses. The techniques utilized to achieve analgesia of the foot and ankle are diverse, multifaceted, and often incorporate ultrasound guidance. Given the aging of patient populations, and especially the growing incidence of cardiovascular-, pulmonary-, and obesity-related morbidity, the use of regional blocks is likely to expand in these surgical procedures. This review highlights some of the most current developments in the expanding role of regional anesthesia in foot and ankle surgery. LEVELS OF EVIDENCE Therapeutic, Level II.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
| | - Alice M Kai
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
| | - Benjamin Maslin
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
| | - Vijay Kodumudi
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
| | - Sible Antony
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
| | - Peter Blume
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (NV, BM, SA)Stony Brook University School of Medicine, Stony Brook, New York (AMK)College of Liberal Arts and Sciences, University of Connecticut, Storrs, Connecticut (VK)Yale-New Haven Hospital, New Haven, Connecticut (PB)
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Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543040-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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30
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Safety and effectiveness of bilateral continuous sciatic nerve block for bilateral orthopaedic foot surgery. Eur J Anaesthesiol 2014; 31:620-5. [DOI: 10.1097/eja.0000000000000027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Young DS, Cota A, Chaytor R. Continuous Infragluteal Sciatic Nerve Block for Postoperative Pain Control After Total Ankle Arthroplasty. Foot Ankle Spec 2014; 7:271-276. [PMID: 24962698 DOI: 10.1177/1938640014537303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Continuous peripheral nerve blocks (CPNB) for postoperative pain control are being used more frequently for total ankle arthroplasty. The purpose of this study was to compare the amount of opioid analgesia used in patients with an infragluteal CPNB to that of patients with no CPNB for postoperative pain management after total ankle replacement. A retrospective cohort study was performed on 78 consecutive patients who had a total ankle arthroplasty from October 2006 to June 2013. The primary outcome measure was opioid analgesia use in the first 48 hours postoperatively. The mean postoperative narcotic use in oral morphine equivalents was 64.6 mg in the CPNB group compared to 129.6 mg in the no CPNB group (P < .001). Using an infragluteal CPNB as a means of postoperative pain control in patients undergoing a total ankle replacement is associated with significantly decreased opioid use compared to patients receiving no CPNB. LEVELS OF EVIDENCE Therapeutic, Level IV, case series.
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Affiliation(s)
- Diana Starr Young
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Adam Cota
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Ruth Chaytor
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
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Lee KT, Park YU, Jegal H, Roh YT, Kim JS, Yoon JS. Femoral and sciatic nerve block for hindfoot and ankle surgery. J Orthop Sci 2014; 19:546-51. [PMID: 24817493 DOI: 10.1007/s00776-014-0576-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/15/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of regional anesthesia, such as ankle block or sciatic nerve block, has gained in popularity due to considerations of patient comfort and safety in foot and ankle surgery. However, if the operation extends above the midfoot or if a thigh tourniquet is required, general or spinal anesthesia is needed. The authors aimed to determine by prospective study whether a 'double block', involving femoral and sciatic nerve blocks, is advantageous under such conditions. MATERIALS AND METHODS The effectiveness of a preoperative double block was prospectively evaluated in 26 consecutive patients undergoing a variety of foot and ankle procedures, compared with 32 patients with sciatic nerve block alone. Time of analgesia onset, length of block coverage, and complications were noted. Degree of pain was measured using VAS (Visual Analog Scale) scores at the operation, just after surgery, and at 2 h, 1 day, and 2 days after surgery. RESULTS The surgical procedures performed under double block were ankle arthroscopy and medial ankle ligament reconstruction, and Achilles tendon repair, and the following conditions were treated; surgery for medial ankle fracture, ankle fusion, subtalar fusion, and surgery for hindfoot diseases, such as, talocalcaneal coalition. The average time required to analgesia onset was 63 min for a double block and 61 min for sciatic nerve block alone. Analgesia time lasted 12.0 h for a double block and 12.4 h for sciatic nerve block alone. Average VAS scores at the operation and immediately after the operation were 0.03 (range 0-1) and 0.16 (range 0-2) for sciatic nerve block, and 0.35 (range, 0-4), 0.31 (range 0-2) for double block. Average VAS scores at 2 h, 1 day, and 2 days postoperatively were 0.28 (range, 0-2), 2.16 (range 0-6), and 1.63 (range 0-5) for sciatic nerve block, and 0.42 (range 0-5), 2.27 (range 0-7), and 1.72 (range 0-8), respectively, for double block. CONCLUSION The results of this prospective study suggest that double block provides good surgical anesthesia and good postoperative pain control for hindfoot and ankle surgery.
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Affiliation(s)
- Kyung Tai Lee
- Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Republic of Korea
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Wang J, Liu GT, Mayo HG, Joshi GP. Pain Management for Elective Foot and Ankle Surgery: A Systematic Review of Randomized Controlled Trials. J Foot Ankle Surg 2014; 54:625-35. [PMID: 24954920 DOI: 10.1053/j.jfas.2014.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Indexed: 02/03/2023]
Abstract
Pain after foot and ankle surgery can significantly affect the postoperative outcomes. We performed a systematic review of randomized controlled trials assessing postoperative pain after foot and ankle surgery, because the surgery will lead to moderate-to-severe postoperative pain, but the optimal pain therapy has been controversial. A systematic review of randomized controlled trials in English reporting on pain after foot and ankle surgery in adults published from January 1946 to February 2013 was performed. The primary outcome measure was the postoperative pain scores. The secondary outcome measures included supplemental analgesic requirements and other recovery outcomes. With 953 studies identified, 45 met the inclusion criteria. The approaches improving pain relief (reduced pain scores or opioid requirements) included peripheral nerve blocks, wound infiltration, intravenous dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 selective inhibitors, and opioids. Wound instillation, intra-articular injection, and intravenous regional analgesia had variable analgesia. The lack of homogeneous study design precluded quantitative analyses. Optimal pain management strategies included locoregional analgesic techniques plus acetaminophen and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors, with opioids used for "rescue," and 1 intraoperative dose of parenteral dexamethasone. Popliteal sciatic nerve blocks would be appropriate when expecting severe postoperative pain (extensive surgical procedure), and ankle blocks and surgical incision infiltration would be appropriate when expecting moderate postoperative pain (less extensive and minimally invasive surgical procedures). Additional studies are needed to assess multimodal analgesia techniques.
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Affiliation(s)
- Jia Wang
- Resident, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Helen G Mayo
- Research and Liaison Librarian, University of Texas Southwestern Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Girish P Joshi
- Professor, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX.
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Hegewald K, McCann K, Elizaga A, Hutchinson BL. Popliteal blocks for foot and ankle surgery: success rate and contributing factors. J Foot Ankle Surg 2013; 53:176-8. [PMID: 23747220 DOI: 10.1053/j.jfas.2013.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to evaluate the factors contributing to the success of popliteal nerve blocks performed by podiatric surgical residents in various stages of training. A retrospective review was conducted of 143 consecutively performed blocks during a 2-year period. A total of 29 blocks using a lateral approach and 114 blocks using a modified posterior approach were performed. The intrinsic and extrinsic variables contributing to block outcome were analyzed. A total of 109 successful blocks were performed, for an overall success rate of 76.2%. Significant differences (p < .002) were found between the success and failure groups with respect to the patients body mass index and age. No differences were observed between the success and failure groups with respect to the block approach or months of resident training. In conclusion, podiatric surgical residents in all stages of training can safely and effectively perform popliteal nerve blocks for peri- and postoperative analgesia. Surgeons should be aware of the potential influence of patients body mass index and age on the overall block success rates.
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Affiliation(s)
- Kenneth Hegewald
- Resident, Foot and Ankle Surgery, Franciscan Health System, Federal Way, WA.
| | | | - Andrew Elizaga
- Anesthesiologist, Department of Anesthesia, Franciscan Health System, Tacoma, WA
| | - Byron L Hutchinson
- Director, Franciscan Foot and Ankle Institute; and Medical Director, Foot and Ankle Service, Franciscan Health System, Federal Way, WA
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Efficacy of popliteal block in postoperative pain control after ankle fracture fixation: a prospective randomized study. J Orthop Trauma 2012; 26:557-61. [PMID: 22732860 DOI: 10.1097/bot.0b013e3182638b25] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare postoperative pain control in patients treated surgically for ankle fractures who receive popliteal blocks with those who received general anesthesia alone. DESIGN Institutional Review Board approved prospective randomized study. SETTING Metropolitan tertiary-care referral center. PATIENTS All patients being treated with open reduction internal fixation for ankle fractures who met inclusion criteria and consented to participate were enrolled. INTERVENTIONS Patients were randomized to receive either general anesthesia (GETA) or intravenous sedation and popliteal block. MAIN OUTCOME MEASURES Patients were assessed for duration of procedure, total time in the operating room, and postoperative pain at 2, 4, 8, 12, 24, and 48 hours after surgery using a visual analog scale. RESULTS Fifty-one patients agreed to participate in the study. Twenty-five patients received popliteal block, while 26 patients received GETA. There were no anesthesia-related complications. At 2, 4, and 8 hours postoperatively, patients who underwent GETA demonstrated significantly higher pain. At 12 hours, there was no significant difference between the 2 groups with regard to pain control. However, by 24 hours, those who had received popliteal blocks had significantly higher pain with no difference by 48 hours. CONCLUSIONS Popliteal block provides equivalent postoperative pain control to general anesthesia alone in patients undergoing operative fixation of ankle fractures. However, patients who receive popliteal blocks do experience a significant increase in pain between 12 and 24 hours. Recognition of this "rebound pain" with early narcotic administration may allow patients to have more effective postoperative pain control.
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Gallardo J, Lagos L, Bastias C, Henríquez H, Carcuro G, Paleo M. Continuous popliteal block for postoperative analgesia in total ankle arthroplasty. Foot Ankle Int 2012; 33:208-12. [PMID: 22734282 DOI: 10.3113/fai.2012.0208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty is associated with severe postoperative pain. Development of analgesic techniques such as a block with continuous infusion at the popliteal level has been shown to result in good pain control, a decrease in the use of rescue analgesia and a low rate of complications. We reviewed our experience with this method of analgesia in patients who underwent total ankle arthroplasty. METHODS A prospective study of 30 patients undergoing total ankle arthroplasty was carried out. Twenty-two of these received and maintained a block at the popliteal level with a continuous infusion of bupivacaine, while the remaining eight received no such block. RESULTS The visual analog scale evaluation (VAS) showed a significant improvement in pain control in the group with the popliteal block after 6, 12, 18, and 24 hours postsurgery, with pain levels peaking and being most different between 6 and 12 hours postsurgery for the two groups. The group with the popliteal block also exhibited a significantly lower consumption of morphine and a greater degree of patient satisfaction. CONCLUSION The block with continuous infusion at the popliteal fossa was a safe technique for total ankle arthroplasty postoperative analgesia, which provided good pain control, a lower requirement of opiates and a higher level of patient satisfaction.
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Affiliation(s)
- Jorge Gallardo
- Instituto Traumatológico, Foot and Ankle Service, San Martin 771, Santiago de Chile 8340220, Chile
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