Femoral and sciatic nerve block for hindfoot and ankle surgery.

Abstract

BACKGROUND: The use of regional anesthesia, such as ankle block or sciatic nerve

block, has gained in popularity due to considerations of patient comfort and

safety in foot and ankle surgery. However, if the operation extends above the

midfoot or if a thigh tourniquet is required, general or spinal anesthesia is

needed. The authors aimed to determine by prospective study whether a 'double

block', involving femoral and sciatic nerve blocks, is advantageous under such

conditions. MATERIALS AND METHODS: The effectiveness of a preoperative double

block was prospectively evaluated in 26 consecutive patients undergoing a variety

of foot and ankle procedures, compared with 32 patients with sciatic nerve block

alone. Time of analgesia onset, length of block coverage, and complications were

noted. Degree of pain was measured using VAS (Visual Analog Scale) scores at the

operation, just after surgery, and at 2 h, 1 day, and 2 days after surgery.

RESULTS: The surgical procedures performed under double block were ankle

arthroscopy and medial ankle ligament reconstruction, and Achilles tendon repair,

and the following conditions were treated; surgery for medial ankle fracture,

ankle fusion, subtalar fusion, and surgery for hindfoot diseases, such as,

talocalcaneal coalition. The average time required to analgesia onset was 63 min

for a double block and 61 min for sciatic nerve block alone. Analgesia time

lasted 12.0 h for a double block and 12.4 h for sciatic nerve block alone.

Average VAS scores at the operation and immediately after the operation were 0.03

(range 0-1) and 0.16 (range 0-2) for sciatic nerve block, and 0.35 (range, 0-4),

0.31 (range 0-2) for double block. Average VAS scores at 2 h, 1 day, and 2 days

postoperatively were 0.28 (range, 0-2), 2.16 (range 0-6), and 1.63 (range 0-5)

for sciatic nerve block, and 0.42 (range 0-5), 2.27 (range 0-7), and 1.72 (range

0-8), respectively, for double block. CONCLUSION: The results of this prospective

study suggest that double block provides good surgical anesthesia and good

postoperative pain control for hindfoot and ankle surgery.