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The Efficacy of Combined Popliteal and Ankle Blocks in Forefoot Surgery

Discussion in 'Foot Surgery' started by NewsBot, Jul 1, 2008.

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  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The Efficacy of Combined Popliteal and Ankle Blocks in Forefoot SurgeryRohit Samuel, Andrew Sloan, Kuntal Patel, Magdy Aglan, and Aamir Zubairy
    The Journal of Bone and Joint Surgery (American). 2008;90:1443-1446.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. drsarbes

    drsarbes Well-Known Member

    hmmmmmmmmmmmmmmmmmmmmm.

    For 30 years I've done post tib block with sup peroneal (and intermet if needed) for forefoot surgery. I've never had a problem. Ever.

    And is there a degree of anesthesia when it comes to nerve blocks? It's like being pregnant, you're either "numb" or you're not.

    Steve
     
  4. Lee

    Lee Active Member

    Steve,
    I think the article really says that popliteal blocks (in combination with an ankle block for some weird reason - probably being impatient) are better for post-op pain relief than ankle blocks alone (although I've only read the abstract above - not the full paper). I have noticed that pop blocks (in isolation, with only a saphenous block as an addition) are great for post-op pain relief and have had great success giving upto 48hrs anaesthesia in some cases (although now I've said it out loud, I've probably cursed myself and they'll never work again).
    Lee
     
  5. drsarbes

    drsarbes Well-Known Member

    (although now I've said it out loud, I've probably cursed myself and they'll never work again).
    Lee

    SO much for speed reading! You're correct.

    Well, just so I can get the last egotistical word........if you're gentle with tissues post op pain will be easy to handle. I normally just give .5% marcaine post op as I would xylocaine pre-op. Seems to work quite well (all things being equal) - If a patient is non compliant all bets are off.

    Steve
     
  6. Ryan McCallum

    Ryan McCallum Active Member

    I too have only read the abstract above and not the whole article but am not entirely sure why the popliteal block was carried out with an ankle block. One or the other I would have thought?
    I do know of a center where they routinely give the patients an ankle block before surgery and then a popliteal block afterwards to provide the prolonged pain relief. I am not entirely sure of the benefits of this but I assume that there must be advantages.
    Personally where I work, the vast majority of patients undergoing surgery have a pop block alone and we find this works very well and like Lee, find that anaesthesia can last up to 48 hrs. I think another advantage with the pop block is that with both sensory and motor loss, the patients almost become disassociated with their foot and therefore can completely relax during surgery. Having said that, in my very limited experience, I've haven't actually seen too many patients become too stressed because they have had an ankle block so this is just really a thought.
    Ryan.
     
  7. Ian Reilly

    Ian Reilly Active Member

    Hi

    My team went to the combination block because we were waiting too long for the pop to go off that a combination ankle block got the patients into theatre quicker. And if the the pop failed, we were losing an hour before the rescue (ankle/Mayo anaestehsai) had taken.


    Steve - your point about being gentle to tissues: kinda difficult with a BFO pneumatic saw!!!


    ATB

    Ian
     
    Last edited: Jul 3, 2008
  8. drsarbes

    drsarbes Well-Known Member

    "your point about being gentle to tissues: kinda difficult with a BFO pneumatic saw!!!"

    I feel your pain! Just watch what you're cutting.

    Re: Anesthesia; Most of my cases are either sedation/nerve block or generals. With the sedation, I do the nerve blocks myself and invariably do a PT block along with whatever anterior nerves I need to block for that case. I use 2% xylocaine and by the time I return to the OR after scrubbing the patients are numb.
    I use .5% marcaine post op on all patients in the same manner as the pre-op block. These patients routinely are numb for 20-25 hours.

    This works rather well for me and the only time I really have a problem with post-op pain is usually a tight bandage or cast. In my experience, if the bandage is tight nothing will help other than splitting the bandage.

    Steve
     
  9. Lee

    Lee Active Member

    Ian,

    How about doing that on the first patient of the day, then getting the other blocks in to give them time to go off while you're doing the first case?

    Did 2 pop blocks today for post op pain relief in 2 patients who the ward managed to balls up the post op analgesia on from surgery 2 days ago. The poor ladies have had 2 days of coping with pain managed by oral paracetamol (that's acetaminophen for our American colleagues) following multiple forefoot surgery. Absolutely textbook technique and procedure, nerve stimulator got tibial and common peroneal straight off. I only wish everyone could be there to see it (including the local anaesthetists who can't their blocks work, so they've turned to ultrasound imaging to help). Tempting fate yet again...............:wacko:

    Steve - "If a patient is non compliant all bets are off" - or if they really can not understand the difference between pressure and sharp no matter how you demonstrate :wacko:. You're 20-25 hour anaesthesia is impressive from ankle stuff. We usually use 3% mepivacaine to get the ankle going, with a bit of 0.5% marcaine just prior to surgery and get about 8 hours out of it on an ankle block. Pop blocks - 2mls 3% mepivacaine to each nerve and 15mls 0.25% marcaine to each nerve (with a saphenous infiltration at the ankle or knee as needed).

    Lee
     
    Last edited: Jul 4, 2008
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Popliteal Blocks for Foot and Ankle Surgery: Success Rate and Contributing Factors
    Kenneth Hegewald, DPM, Kevin McCann, DPM, Andrew Elizaga, MD, Byron Hutchinson, DPM, FACFAS
    Journal of Foot and Ankle Surgery; Article in Press
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Efficacy and safety of ankle block versus sciatic-saphenous nerve block for hallux valgus surgery
    Ayman I Tharwat, Ossama El Shazly
    Ain-Shams J Anaesthesiol 2014;7:376-80
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Liposomal Bupivacaine in Forefoot Surgery.
    Robbins J, Green CL, Parekh SG
    Foot Ankle Int. 2015 Jan 22.
     
  13. I am currently seeing a 61 year old man, who is very fit, but had foot surgery 6 months ago (to remove a screw in the 5th metatarsal) by another podiatrist and developed a slight drop foot deformity (i.e. weak ankle dorsiflexors) immediately after the foot surgery where a popliteal block was used for anesthesia. The anesthesiologist did his popliteal block, not the podiatrist.

    I've never seen this complication from popliteal nerve block before but certainly it is something to consider before one starts poking needles around the very large nerves in the knee.
     
  14. Dieter Fellner

    Dieter Fellner Well-Known Member

    Our local foot & ankle orthopedic surgeon is forever fighting with the anesthesiology team who want to do pop blocks, in part to fulfill their teaching commitment. The risk of a nerve palsy, they say, is 1:100. Our orthopod is left to manage 2 such cases in his clinic, in the time I was with him, during the most recent rotation, over a period of 1 month. At that point the anesthesiology team are long gone, and the foot & ankle doctor is left to pick up the pieces. Needless to say he is no longer interested in pop blocks and will take GA / IV sedation and pain meds after surgery, over the promise of 24-28 hours of pain relief from the block.
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison Between Ultrasonography-Guided Popliteal Sciatic Nerve Block and Spinal Anesthesia for Hallux Valgus Repair
    Sermin Karaarslan et al
    Foot & Ankle International August 20, 2015
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Popliteal Nerve Block in Foot and Ankle Surgery: an Efficient and
    Anatomical Technique

    Michael B Canales et al
    J Anesth Clin Res 2015, 6:8 (full text)
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery.
    Dawson RL et al
    Anaesthesia. 2015 Dec 18. doi: 10.1111/anae.13346
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery
    R. L. Dawson et al
    Anaesthesia; Early View
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A comparison of ankle block and spinal anesthesia for foot surgery.
    Urfalioglu A et al
    Int J Clin Exp Med. 2015 Oct 15;8(10):19388-93
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The effect of preemptive ankle block using ropivacaine and dexamethasone on postoperative analgesia in foot surgery.
    Alzeftawy AE, Elsheikh NA.
    Anesth Essays Res 2017;11:372-5
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The Effect of Preemptive Ankle Block using Ropivacaine and Dexamethasone on Postoperative Analgesia in Foot Surgery.
    Alzeftawy AE, Elsheikh NA
    Anesth Essays Res. 2017 Apr-Jun;11(2):372-375. doi: 10.4103/0259-1162.206275.
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison
    Oliver N. Schipper, MD, Kenneth J. Hunt, MD, Robert B. Anderson, MD, ...
    Foot & Ankle International August 17, 2017
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The Effects of Timing of Ankle Blocks in Forefoot, Midfoot, or Hindfoot Reconstruction With the Use of an Ankle Tourniquet.
    Gwosdz J et al
    Foot Ankle Spec. 2018 Jan 1:1938640017754233. doi: 10.1177/1938640017754233
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The Importance of the Saphenous Nerve Block for Analgesia
    Following Major Ankle Surgery
    A Randomized, Controlled, Double-Blind Study

    Siska Bjørn et al
    Reg Anesth Pain Med 2018;43: 00–00
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Is regional ankle block needed in conjunction with general anaesthesia for first ray surgery? A randomised controlled trial of ultrasound guided ankle block versus “blind” local infiltration
    Veronica I.RobertsRandeep S.AujlaFelix N.FombonHarvinderSinghManeeshBhatia
    Source
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Pretreatment of ankle nerve block provides better
    postoperative analgesia than peri-incisional local anesthetic
    infiltration in hallux valgus correction surgery

    Miao-Pei Su et al
    Kaohsiung J Med Sci. 2019;35:168–174.
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The efficacy and safety of continuous versus single-injection popliteal sciatic nerve block in outpatient foot and ankle surgery: a systematic review and meta-analysis.
    Ma HH et al
    BMC MusculoskeletDisord. 2019 Oct 10
     
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