Continuous Infusion Versus Single Bolus Popliteal Block Following Major Ankle and Hindfoot Surgery: A Prospective, Randomized Trial

Department of Trauma and Orthopedic Surgery, Basingstoke and North Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
Foot & Ankle International (Impact Factor: 1.51). 12/2010; 31(12):1043-7. DOI: 10.3113/FAI.2010.1043
Source: PubMed


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. [21] 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. [22] reported that this procedure increases pain relief after surgery, thus improving patient satisfaction. "
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