Continuous Infusion Versus Single Bolus Popliteal Block Following Major Ankle and Hindfoot Surgery: A Prospective, Randomized Trial
ABSTRACT Popliteal sciatic nerve blockade is a commonly used technique employed in the management of postoperative pain following foot and ankle surgery. Recent studies have shown that for outpatient surgery, for moderately painful procedures, a continuous infusion of local anesthesia via an in-dwelling catheter for 48 to 72 hours leads to reduced opiate analgesic requirements and improved pain and patient satisfaction scores.
A prospective, randomized, double blind, placebo-controlled trial of a continuous infusion of bupivacaine verses normal saline via a popliteal catheter after a single bolus popliteal block for 72 hours after major ankle and hind foot surgery was performed in 54 patients.
The average pain scores overall were low (range, 1.1 to 3.6 on a Visual Analogue Scale of 0 to 10) throughout the study period. Statistically significantly lower pain scores with significantly less requirement for supplementary opiate analgesic agents were seen in the treatment group.
Despite the statistically significant findings, with such low pain scores in both groups, we believe it remains debatable whether the extra time and cost involved warrants the use of a continuous popliteal blockade over a single bolus injection.
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- "Furthermore, 95% of PSNB patients showed satisfaction, including "average" satisfaction. Elliot et al.  reported that continuous nerve block due to sciatic nerve catheterization after foot and ankle joint surgery can reduce the need for extra pain relief and pain after surgery. Navas et al.  reported that this procedure increases pain relief after surgery, thus improving patient satisfaction. "
ABSTRACT: We compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery. Forty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer. Procedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P < 0.01). Anesthesia-related complications such as hypotension, bradycardia, shivering, nausea/vomitting, post-dural puncture headache (PDPH) and urinary retension were observed in 15%, 10%, 5%, 5%, 10%, and 20% of patients in the spinal group, respectively. PSNB was not associated with these complications. Patient satisfaction was slightly higher for PSNB than for spinal anesthesia. In the PSNB group, patient satisfaction with postoperative pain-control was 95% above ordinary satisfaction. Despite the long duration of the procedure, PSNB is relatively safe, provides an adequate level of anesthesia, effectively controls postoperative pain and reduces side effects. Therefore, PSNB could be a potential anesthetic technique for hallux valgus surgery.Korean journal of anesthesiology 04/2013; 64(4):321-6. DOI:10.4097/kjae.2013.64.4.321
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ABSTRACT: Total ankle arthroplasty is associated with severe postoperative pain. Development of analgesic techniques such as a block with continuous infusion at the popliteal level has been shown to result in good pain control, a decrease in the use of rescue analgesia and a low rate of complications. We reviewed our experience with this method of analgesia in patients who underwent total ankle arthroplasty. A prospective study of 30 patients undergoing total ankle arthroplasty was carried out. Twenty-two of these received and maintained a block at the popliteal level with a continuous infusion of bupivacaine, while the remaining eight received no such block. The visual analog scale evaluation (VAS) showed a significant improvement in pain control in the group with the popliteal block after 6, 12, 18, and 24 hours postsurgery, with pain levels peaking and being most different between 6 and 12 hours postsurgery for the two groups. The group with the popliteal block also exhibited a significantly lower consumption of morphine and a greater degree of patient satisfaction. The block with continuous infusion at the popliteal fossa was a safe technique for total ankle arthroplasty postoperative analgesia, which provided good pain control, a lower requirement of opiates and a higher level of patient satisfaction.Foot & Ankle International 03/2012; 33(3):208-12. DOI:10.3113/FAI.2012.0208 · 1.51 Impact Factor
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ABSTRACT: Many practitioners consider continuous peripheral nerve blocks (cPNBs) to be superior to single-injection peripheral nerve blocks (siPNBs). Several randomized controlled trials have demonstrated improved pain control, patient satisfaction, and other outcomes for patients with cPNBs compared with patients with siPNBs, whereas other trials have not shown significant differences. We sought to clarify any potential advantages of cPNBs over siPNBs. We conducted a systematic review and meta-analysis of all prospective, randomized trials comparing cPNBs with siPNBs. We used a validated systematic search strategy to identify potentially eligible studies. For studies meeting inclusion criteria, methodologic quality was scored independently by 2 reviewers. Data from the studies were abstracted and pooled for meta-analysis. Compared with siPNBs, cPNBs were associated with a decreased rating of worst pain on postoperative day 0 (effect size [ES], -1.29; 95% confidence interval [CI], -2.19 to -0.40; P = 0.005), postoperative day 1 (ES, -1.87; 95% CI, -2.44 to -1.31; P < 0.001), and postoperative day 2 (ES, -2.03; 95% CI, -2.78 to -1.290; P < 0.001); decreased overall opioid use (ES, -15.70; 95% CI, -21.84 to -9.55; P < 0.001); less nausea (ES, 0.633; 95% CI, 0.407-0.983; P = 0.043); and higher patient satisfaction scores (weighted mean difference, -2.04; 95% CI, 1.24-2.85; P < 0.001). Compared with siPNBs, cPNBs were associated with improved pain control, decreased need for opioid analgesics, less nausea, and greater patient satisfaction. The effect of cPNBs on other clinically relevant outcomes, such as complications, long-term functional outcomes, or costs, remains unclear.Regional anesthesia and pain medicine 10/2012; 37(6):583-94. DOI:10.1097/AAP.0b013e31826c351b · 3.09 Impact Factor