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

2017 ◽  
Vol 39 (3) ◽  
pp. 332-337 ◽  
Author(s):  
Kathleen Jarrell ◽  
Elizabeth McDonald ◽  
Rachel Shakked ◽  
Kristen Nicholson ◽  
Vincent Kasper ◽  
...  
Keyword(s):  
Nerve Block ◽  
Continuous Flow ◽  
Single Injection ◽  
Outpatient Setting ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Catheter Group ◽  
Ankle Surgery

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.

scholarly journals Combined Popliteal Catheter with Single Injection Versus Continuous Infusion Saphenous Nerve Block

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Steven Raikin ◽  
Rachel Shakked ◽  
Elizabeth McDonald ◽  
Kristen Nicholson ◽  
Kathleen Jarrell ◽  
...  
Keyword(s):  
Pain Relief ◽  
Continuous Infusion ◽  
Nerve Block ◽  
Pain Control ◽  
Single Injection ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Post Operative Pain ◽  
Catheter Group ◽  
Ankle Surgery

Category: Ankle, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Surgical and analgesic advancements have increasingly allowed more foot and ankle procedures to be performed on an outpatient basis. Dual nerve blockade of saphenous and popliteal nerves minimizes post-operative pain, and continuous infusion via catheter can provide extended pain relief. In our experience, the combination of popliteal nerve catheters and single-shot saphenous nerve block effectively eliminates post-operative pain after most foot and ankle surgery. However, the early return of pain in the saphenous nerve distribution can cause early discomfort and even readmission for pain control. We hypothesized that patients receiving continuous popliteal nerve infusion with single-injection saphenous nerve block (single) will have greater post-operative pain than those patients receiving continuous popliteal and saphenous nerve infusion (dual). Methods: A cohort of 62 patients undergoing outpatient foot and ankle surgery by a single fellowship trained orthopaedic surgeon were prospectively, sequentially enrolled. The surgeon rated each procedure for degree of saphenous involvement as limited, moderate, or extensive. Demographics, American Society of Anesthesiologists physical status classification system (ASA), anesthesia time and post-anesthesia care unit (PACU) time were documented. Total analgesia requirement and reported numeric pain score (NPS) at rest and with activity were recorded. Student’s t-test and chi-square test were utilized for single and dual block comparisons, and one-way ANOVA tested for differences in saphenous involvement. Results: The dual catheter group took significantly less opioid medication on post-operative day (POD) 1 compared to the single catheter group (Table 1; p=0.02). The dual catheter group reported significantly greater satisfaction with pain at POD 1 and POD 3 (p=0.03) and a significantly lower NPS at POD 1 and POD 2 (p=0.005). This trend is observed in all 3 subgroups of medial involvement. Patients in the single catheter group report about twice as much pain as patients in the dual catheter group when medial involvement was limited (7.4 v 3.8; p=0.033) or moderate (5.9 v 3.4; p=0.025). For patients with extensive medial involvement, pain was reduced when dual blocks were employed (5.4 v 6.7), but this difference was not significant (p=0.288). Conclusion: Patients in the single catheter group reported more pain and less satisfaction with pain control on POD 1, suggesting dual catheter use is superior to managing early post-operative pain in outpatient foot and ankle surgery. Interestingly, degree of medial involvement did not seem to correlate with better pain control within the dual group; in contrast, patients with less medial involvement reported better pain relief with dual than with a single catheter. From a pain management perspective, discharging patients on the day of routine outpatient foot and ankle surgery is appropriate with the judicious use of perioperative continuous infusion nerve catheters.

Response to “Letter Regarding: Combined Popliteal Catheter With Single-Injection vs Continuous-Infusion Saphenous Nerve Block for Foot and Ankle Surgery”

2018 ◽  
Vol 39 (5) ◽  
pp. 638-638
Author(s):  
Steven M. Raikin ◽  
Kathleen Jarrell ◽  
Elizabeth McDonald ◽  
Rachel Shakked ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Nerve Block ◽  
Single Injection ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Ankle Surgery

scholarly journals A Comparison of Two Methods of Regional Anesthesia

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Andrew Stith ◽  
Matthew Griffin ◽  
Thomas Haytmanek ◽  
Christopher Hirose
Keyword(s):  
Patient Satisfaction ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Single Agent ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Nerve Blocks ◽  
Pain Scores ◽  
Ankle Surgery ◽  
Significant Difference

Category: Other Introduction/Purpose: Poorly controlled post-operative pain is a common cause of patient dissatisfaction. With future emphasis on value-based medicine, optimization of cost-effectiveness and patient satisfaction is critical. Popliteal and saphenous nerve blocks are routinely use in foot and ankle orthopaedic surgery and have become the gold standard for immediate post-operative analgesia. Traditionally a single long-acting local anesthetic agent is utilized which achieves analgesia for 6-24 hours. Recent evidence has shown that multimodal anesthesia with combined anesthetic agents remains effective for a longer duration compared to single-medication nerve blocks. The purpose of this study is to determine if patients undergoing foot and ankle surgery safely benefit from multi-modal compared with traditional single-medication nerve blocks. Methods: This was a two-armed, prospective, randomized, double-blinded study. The study population consisted of 70 patients from a single institution undergoing foot and ankle surgery by two fellowship-trained orthopaedic foot and ankle surgeons. 34 patients received a local anesthetic only popliteal and saphenous nerve block (Bupivacaine) and the other 36 patients received a triple additive nerve block (Dexamethasone, Clonidine, and Buprenorphine) in addition to Bupivacaine. Pre- and Post-operative assessments were performed to determine VAS pain scores, numbness, duration of anesthesia, patient satisfaction with analgesia, and oral pain medication use. Results: Triple additive (TA) nerve block mean duration to onset of pain was longer than for single agent (LA) nerve blocks (40.2 hrs vs 24.3 hrs respectively). Time to complete block resolution was also longer for the TA nerve blocks (82.3 hours) compared to LA blocks (38.7 hrs). 17/34 TA block patients had residual numbness at 1 week compared to 5/36 LA block patients. However, by 3 months there was no difference (8/34 TA and 7/36 LA). There was no significant difference in VAS scores or patient satisfaction rates at 1 week or 3 months. 7/34 TA block patients required narcotic refills compared to 6/36 LA block patients. There was no significant difference in complications between the groups. Conclusion: Triple agent nerve blocks give a longer duration of effective postoperative analgesia compared to single agent blocks. There was a higher rate of lingering numbness in the triple agent blocks at one week but not at 3 months. Patient satisfaction was very high for both groups regardless of their VAS pain scores. Triple agent nerve blocks demonstrate equivalent safety compared with single agent nerve blocks.

Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery

2017 ◽  
Vol 42 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Siska Bjørn ◽  
Frank Linde ◽  
Kristian K. Nielsen ◽  
Jens Børglum ◽  
Rasmus Wulff Hauritz ◽  
...  
Keyword(s):  
Nerve Block ◽  
Single Injection ◽  
Saphenous Nerve ◽  
Ankle Surgery

scholarly journals Ideal Anatomic Location for Saphenous Nerve Block for Foot and Ankle Surgeries: A Prospective Randomized Clinical Evaluation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Karl Henrikson ◽  
Sanjib Adhikary ◽  
Gregory Pace ◽  
Wai Liu ◽  
Paul Juliano ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Score ◽  
Nerve Block ◽  
Knee Extension ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Nerve Blocks ◽  
Knee Extension Strength ◽  
Significant Difference ◽  
Isometric Knee Extension

Category: Regional anesthesia for foot and ankle surgery Introduction/Purpose: Regional anesthesia has resulted in significant improvements in patient outcomes including reduced postoperative pain, opioid consumption, opioid-related adverse effects, and decreased postoperative length of stay. Saphenous nerve blocks provide distal analgesia while minimizing the reduction in quadriceps strength seen with more proximal femoral nerve blocks. Saphenous nerve blocks may be performed at the mid-thigh with the subsartorial technique or just proximal to the knee with the transsartorial technique. The present study compares these two techniques in terms of analgesia effectiveness and quadriceps motor preservation. Methods: This study was approved by our institutional IRB committee. A power analysis was conducted prior to the study. Patients, aged 18 to 65, were prospectively identified from a list of elective foot and ankle surgeries performed by one of the study investigators. Preoperatively, bilateral isometric knee extension strength was measured, and subjects completed a PROMIS global health survey. The surgeon was blinded to the randomization of patients to proximal or distal blocks. Bilateral isometric knee extension strength was reassessed following the block as well as sensation, post-operative visual analogue pain score (VAS), and subjective satisfaction. Due to non-normality of the sample, the Wilcoxon rank-sum test was employed to analyze continuous variables such as strength measures. For categorical variables such as gender, pain score, and patient satisfaction, the Pearson chi- square test was used. Results: Twenty-four patients (24 lower extremities) were enrolled in the study and 12 randomized to each group. The two groups were not significantly different in age, gender, or pre-operative PROMIS Mental and Physical Summary Scores. The nerve block procedure was successfully performed in a single attempt in all cases. The VAS was not significantly different at 2 in the distal group and 3 in the proximal group. In each group 11 patients were totally satisfied with the block and 1 was moderately satisfied. The knee extension strength decreased in both the operative and non-operative lower extremity following administration of the nerve block. When normalized to the effect in the non-operative extremity, there was no significant difference in strength decrease between the two groups (p=0.89). Conclusion: This randomized, single-blinded trial compared proximal subsartorial saphenous nerve block with distal transsartorial saphenous nerve block outside of the adductor canal. There was no significant difference in the efficacy of the two techniques was observed in terms of VAS pain score or patient satisfaction and no difference in post-operative weakness. This is the first randomized trial on saphenous nerve blocks to normalize strength to the non-operative lower extremity, reducing the confounding effect of peri-operative narcotic and sedative medications. This study offers evidence for equivalence of the subsartorial and transsartorial saphenous nerve block techniques.

scholarly journals 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

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Single Injection ◽  
Meta Analysis ◽  
Sciatic Nerve Block ◽  
Cochrane Library ◽  
Foot And Ankle ◽  
Efficacy And Safety ◽  
Outcome Parameters ◽  
Ankle Surgery

Abstract Background Continuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. Its efficacy as well as safety is yet to be established. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB. Methods We performed a comprehensive literature review on Web of Science, the Cochrane Library, PubMed and Embase and only included randomized controlled trials (RCTs). Five RCTs that compared the efficacy and safety of CPSNB with the single-injection popliteal sciatic nerve block group were included. The primary outcome parameters were visual analog scale (VAS) scores at postoperative 24, 48 and 72 h. The secondary outcome parameters were amount of oral analgesics consumed, overall patient satisfaction and need of admission after surgery. A sensitivity analysis was performed to explore the consistency of the results. Results In comparison with the single-injection group, CPSNB was associated with a lower VAS score at postoperative 24 and 48 h (p < 0.05). There were no neuropathic symptoms or infection events after the nerve block. However, there were several minor complications associated with the pump and catheter system, with drug leakage being the most common complication (N = 26 of 187, 13.9%). Conclusion CPSNB is an effective method in pain management for outpatient foot and ankle surgery. Both methods appear to be safe as none of the patients experienced neuropathic symptoms or infection. Further studies with larger sample size are needed to compare the risk of major complications between the two methods. Level of evidence I; meta-analysis.

The Importance of the Proximal Saphenous Nerve Block for Foot and Ankle Surgery

2013 ◽  
Vol 38 (4) ◽  
pp. 372 ◽  
Author(s):  
Junping Chen ◽  
Jonathan Lesser ◽  
Admir Hadzic ◽  
Francesco Resta-Flarer
Keyword(s):  
Nerve Block ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Ankle Surgery

scholarly journals Foot Surgery in Vanuatu: Results of Combined Tibial, Common Peroneal and Saphenous Nerve Blocks in Fifty-six Adults

1989 ◽  
Vol 17 (3) ◽  
pp. 336-339 ◽  
Author(s):  
C. J. Sparks ◽  
T. Higeleo
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Saphenous Nerve ◽  
Popliteal Fossa ◽  
Constant Current ◽  
Foot And Ankle ◽  
Nerve Stimulator ◽  
Foot Surgery ◽  
Nerve Blocks ◽  
Ankle Surgery

Combined tibial and common peroneal nerve anaesthesia was used for foot and ankle surgery in fifty-six adults. Where necessary, the saphenous nerve was also blocked. A calibrated constant current nerve stimulator was used to localise the nerves in the popliteal fossa. Using lignocaine 1%, an opioid premedication, but no other sedation or top-up injection, 60% of the blocks were successful. If a patient felt pain at incision or during surgery, the block was recorded as a failure.

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

2009 ◽  
Vol 30 (9) ◽  
pp. 854-859 ◽  
Author(s):  
Sokratis E. Varitimidis ◽  
Aaron I. Venouziou ◽  
Zoe H. Dailiana ◽  
Dimitrios Christou ◽  
Apostolos Dimitroulias ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Nerve Block ◽  
Case Series ◽  
Orthopaedic Surgeon ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Simple Method ◽  
Ankle Surgery

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

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