Triple Nerve Block at the Knee for Foot and Ankle Surgery Performed by the Surgeon: Difficulties and Efficiency

Abstract

Background:

Combined nerve blocks at the knee can provide safe anesthesia below the knee avoiding the potential complications of general or spinal anesthesia while reducing the need for opioids in the postoperative period. This study presents the outcomes of a large series of patients that underwent foot and ankle surgery receiving a triple nerve block at the knee.

Materials and Methods:

Three hundred eighty patients underwent foot and ankle surgery receiving anesthesia with triple nerve block at the knee (tibial, common peroneal and saphenous nerve). Surgery included a variety of bone and soft tissue procedures. The nerve block was performed by an orthopaedic surgeon in the lateral decubitus position.

Results:

The successful nerve block rate was 91 percent. There was no need to convert to general or spinal anesthesia, although 34 patients (9%) needed additional analgesia intraoperatively. Complete anesthesia required 25 to 30 minutes from the time of performing the block. No complication occurred secondary to the use of the anesthetic agent (ropivacaine 7.5%). Postoperative analgesia lasted from 5 to 12 hours, reducing the need of additional analgesics. Hospitalization averaged 1.4 days (from 0 to 5) with the majority of patients discharged the day after the operation (248/380). A high satisfaction rate was reported by the patients with no adverse effects and complications.

Conclusion:

We found triple nerve block at the knee to be a safe and reliable method of regional anesthesia providing low morbidity, high success rate, long acting analgesia, and fewer complications than general or spinal anesthesia. It is a simple method that can be performed by the orthopaedic surgeon.

Level of Evidence: IV, Retrospective Case Series

Keywords

Popliteal Block Tibial Nerve Block Peroneal Nerve Block Saphenus Nerve Block Regional Anesthesia Peripheral Nerve Block Foot and Ankle Surgery

Get full access to this article

View all access options for this article.

References

1 Benzon

Kim

Benzon

: Correlation between evoked motor response of the sciatic nerve and sensory blockade. Anesthesiology. 87:547–552, 1997. https://dx-doi-org.web.bisu.edu.cn/10.1097/00000542-199709000-00014.

2 Brown

Ed.: Regional Anesthesia and Analgesia. Philadelphia: W.B. Saunders, 1996.

3 Carles

Pulcini

Macchi

: An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): The efficacy, safety and predictive criteria of failure. Anesth Analg. 92:194–198, 2001. https://dx-doi-org.web.bisu.edu.cn/10.1097/00000539-200101000-00037.

4 Curatolo

Orlando

Zbinden

Venuti

: Failure rate of epidural anaesthesia for foot ankle surgery: A comparison with other surgical procedures. Eur J Anaesthesiol. 12:363–367, 1995.

5 Dhukaram

Kumar

: Nerve blocks in foot and ankle surgery. Foot Ankle Surg. 10:1–3, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1268-7731(03)00099-7.

6 Donohue

Goss

Metz

Weingarten

Dyal

: Combined popliteal and Saphenus nerve blocks at the knee-an underused alternative to general or spinal anesthesia for foot and ankle surgery. J Am Podiatr Med Assoc. 94:368–374, 2004.

7 Flaatten

Raeder

: Spinal anaesthesia for outpatient surgery. Anaesthesia. 40:1108–1111, 1985. https://dx-doi-org.web.bisu.edu.cn/10.1111/j.1365-2044.1985.tb10612.x.

8 Gold

Kitz

Lecky

Neuhaus

: Unanticipated admission to the hospital following ambulatory surgery. JAMA. 262:3009–3010, 1989. https://dx-doi-org.web.bisu.edu.cn/10.1001/jama.262.21.3008.

9 Greengrass

: Regional anesthesia for ambulatory surgery. Anesthsiol Clin North America. 18:341–353, 2000. https://dx-doi-org.web.bisu.edu.cn/10.1016/S0889-8537(05)70167-X.

10.

10 Hansen

Eshelman

Cracchiolo

3rd : Popliteal fossa neural blockade as the sole anesthetic technique for outpatient foot and ankle surgery. Foot Ankle Int. 21:38–44, 2000.

11.

11 Jarrett

Rongstad

Snyder

: Popliteal nerve block by surgeon in the lateral decubitus position. Foot Ankle Int. 25:37–8, 2004.

12.

12 Migues

Slulitel

Vescovo

: Peripheral foot blockage versus popliteal foossa nerve block: A prospective randomized trial in 51 patients. J Foot Ankle Surg. 44:354–367, 2005. https://dx-doi-org.web.bisu.edu.cn/10.1053/j.jfas.2005.07.005.

13.

13 Myerson

Ruland

Allon

: Regional anesthesia for foot and ankle surgery. Foot Ankle. 13:282–288, 1992.

14.

14 Pither

Raj

Ford

: The use of nerve stimulators for regional anesthesia. A review of experimental characteristics, technique and clinical implications. Reg Anesth. 10:49–58.

15.

15 Provenzano

Viscusi

Admas

: Safety and efficacy of the popliteal fossa block when utilized for foot and ankle surgery. Foot Ankle Int. 23:394–399, 2002.

16.

16 Reilley

Terebuch

Gerhardt

: Regional anesthesia techniques for the lower extremity. Foot Ankle Clin. 9:349–372, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1083-7515(03)00157-8.

17.

17 Rongstad

Mann

Prieskorn

Nichelson

Horton

: Popliteal sciatic nerve block for postoperative analgesia. Foot Ankle Int. 17:378–382, 1996.

18.

18 Rorie

Byer

Nelson

Sittipong

Johnson

: Assessment of block of the sciatic nerve in the popliteal fossa. Anesth Analg. 59:371–376, 1980. https://dx-doi-org.web.bisu.edu.cn/10.1213/00000539-198005000-00010.

19.

19 Rose

: A comparison of regional and general anesthesia. In: Wedel

, Ed., Orthopaedic Anesthesia. New York: Churchill Livingstone. 69–98, 1993.

20.

20 Singelyn

Gouverneur

Gribomont

: Popliteal sciatic nerve block aided by a nerve stimulator: A reliable technique for foot and ankle surgery. Reg Anesth. 16:278–81, 1991.

21.

21 Taboada

Rodriguez

Alvarez

: Sciatic nerve block via posterior Labat approach is more efficient than lateral popliteal approach using a double-injection technique: A prospective, randomized comparison. Anesthesiology. 101:138–42, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1097/00000542-200407000-00022.

22.

22 Wu

Naqibuddin

Fleisher

: Measurement of patients satisfaction as an outcome of regional anesthesia and analgesia, a systemic review. Reg Anesth Pain Med. 26:196–208, 2001.