Combined Popliteal Catheter With Single-Injection vs Continuous-Infusion Saphenous Nerve Block for Foot and Ankle Surgery

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.

Keywords

popliteal block tibial nerve block peroneal nerve block peripheral nerve block saphenous nerve block postoperative pain relief continuous infusion single injection ambulatory surgery foot and ankle surgery

Get full access to this article

View all access options for this article.

References

Candido

Hennes

Gonzalez

et al . Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivicaine in patients receiving infragluteal sciatic nerve block. Anesthesiology. 2010;113:1419-1426.

Caneles

Huntley

Reiner

et al . The popliteal nerve block in foot and ankle surgery: an efficient and anatomical technique. J Anesth Clin Res. 2015;6:553.

Chen

Lesser

Hadzic

et al . The importance of the proximal saphenous nerve block for foot and ankle surgery. Reg Anesth Pain Med. 2013;38:372.

Donohue

Goss

Metz

et al . Combined popliteal and saphenous nerve blocks at the knee: an underused alternative to general or spinal anesthesia for foot and ankle surgery. J Am Podiatr Med Assoc. 2004;94(4):368-374.

Fisker

Iversen

Christensen

et al . Combined saphenous and sciatic catheters for analgesia after major ankle surgery: a double-blinded randomized controlled trial. Can J Anaesth. 2015;62(8):875-882.

Gonzalez

Fisk

Chiodo

et al . Economic analysis and patient satisfaction associated with outpatient total ankle arthroplasty. Foot Ankle Int. 2017;38(5):507-513.

Ilfeld

BM.

Continuous peripheral nerve blocks: a review of the published literature. Anesth Analg. 2011;113(4):904-925.

Ilfeld

Mariano

Williams

et al . Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis. Reg Anesth Pain Med. 2007;32(1);46-54.

Ilfeld

Morey

Wang

et al . Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology. 2002;97(4):959-965.

10.

Klein

Greengrass

Grant

et al . Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade. Can J Anaesth. 2001;48(4):375-378.

11.

Perlas

Lau

et al . Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery—a retrospective cohort study. J Clin Anesth. 2016;35:20-25.

12.

Pearce

Hamilton

PD.

Current concepts review: regional anesthesia for foot and ankle surgery. Foot Ankle Int. 2010;31(8):732-739.

13.

Rawal

Hylander

Nydahl

et al . Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand. 1997;41(8):1017-1022.

14.

Rongstad

Mann

Prieskorn

et al . Popliteal sciatic nerve block for postoperative analgesia. Foot Ankle Int. 1996;17(7):378-382.

15.

Rorie

Byer

Nelson

et al . Assessment of block of the sciatic nerve in the popliteal fossa. Anesth Analg. 1980;59(5):371-376.

16.

Saporito

Petri

Sturini

et al . Safety and effectiveness of bilateral continuous sciatic nerve block for bilateral orthopaedic foot surgery: a cohort study. Eur J Anaesthesiol. 2014;31(11):620-625.

17.

Saporito

Sturini

Borgeat

et al . The effect of continuous popliteal sciatic nerve block on unplanned postoperative visits and readmissions after foot surgery—a randomized, controlled study comparing day-care and inpatient management. Anaesthesia. 2014;69(11);1197-1205.

18.

Singelyn

Aye

Gouverneur

JM.

Continuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery. Anesth Analg. 1997;84(2):383-386.

19.

Varitimidis

Venouziou

Dailiana

et al . Triple nerve block at the knee for foot and ankle surgery performed by the surgeon: difficulties and efficiency. Foot Ankle Int. 2009;30(9):854-859.

20.

White

Issioui

Skrivanek

et al . The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003;97(5):1303-1309.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.24 MB