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Anaesthesia ideas for lessor toenail surgery

Discussion in 'General Issues and Discussion Forum' started by Adrian Misseri, Jul 10, 2009.

  1. Adrian Misseri

    Adrian Misseri Active Member


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    G'day all,

    Just after a couple of ideas. I have a patient who I've been managing conservatively for chauxic toenails for the last few years. A little while ago, I removed both 1st nails successfully. Recently, she has decided that she'd like to have all the lessor nails removed as well, as they get very uncomfortable in all of her footwear, and conservative management with clippers and burr only keeps her pain free for a couple of weeks.

    My question is this; what is the best way for me to approach this from an anaesthesia point of view. I'm planning on doing each foot as separate surgeries, but am I better off to use a full ankle block, bilateral blocks to each digit, or aim slightly more proximally for the (distal part of the) common metatarsal nerves, just before they divide to enter each digit. Ideally, I'm after a technique which will reduce the amount of both anaesthetic I have to use as well as actual actual injections I have to give the patient, and I'd like to keep the amount of surgical visits for the patient to a minimum

    Any ideas? :confused:
     
  2. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Adrian,

    If removal is what you intend to do my personal suggestions is gain anesthesia via the simplest way possible and the way in which you feel most comfortable.

    I would prefer to do a post tib and med/lat dorsal cutaneous (superficial peroneal) block myself to save time/hassle - however I also see nothing wrong with individual digital blocks. I would do both feet at once with no real concerns.

    I would use 1% lignocaine plain. Your MSDD for this is 200mg per day, I would imagine that regardless of the injection technique used you should be able to get away with 5-10mls (50-100mg) on each foot, hence not breaching any MSDD.

    Hope this helps!
     
  3. Most I've ever done is 8 nails in one sitting. 3% mepivicaine and I used about 10mls. I used digital blocks simply because that's what I'm most familier with but like the above poster says, it's what you're comfy with.

    Regards
    Robert
     
  4. Lee

    Lee Active Member

    Ankle block. Everything but the saphenous nerve.
     
  5. Adrian:

    An ankle block would be the preferred method, if you are good at ankle blocks. If you are not comfortable with ankle blocks, then stick to multiple digital blocks.
     
  6. W J Liggins

    W J Liggins Well-Known Member

    Hi Adrian

    I'd go along with the ankle block, possibly omitting the saphenous block. The deep peroneal seems to frequently send a branch to the 2nd toe, so you need to deal with that as well.

    All the best

    Bill

    PS. We hate Ricky Ponting (amongst a small additional selection of Aussies) just at the moment. Yippee, it's going to rain!
     
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