Preoperative lateral popliteal nerve block for intraoperative and postoperative pain control in elective foot and ankle surgery: a prospective analysis.

BACKGROUND: Limiting postoperative pain and minimizing systemic narcotic complications are important considerations in foot and ankle surgery to maximize patient comfort and promote early discharge from the hospital. Nerve blocks are valuable additions to perioperative care. A variety of nerve blocks have been advocated, but few reports have evaluated a preoperative supine approach for popliteal block in foot and ankle surgery.

METHODS: We prospectively evaluated the effectiveness of a preoperative popliteal block in 25 consecutive patients undergoing a variety of foot and ankle procedures, as well as the length of block coverage, patient satisfaction, and any complications. Patients were monitored clinically and by a questionnaire at various time increments: preoperatively, in the post-anesthesia care unit (PACU), postoperative day one, and postoperative week one.

RESULTS: Postoperatively, 15 of 25 patients had a complete block (motor and sensory), five of 25 patients demonstrated motor function, but denied sensation or pain, and the remaining five of 25 had sensation to light touch but no motor function or pain. None of the patients reported pain postoperatively in the PACU within an hour after surgery. The average time the block lasted was 14 hours. Overall satisfaction with the block on postoperative day one and week one was 4.8 out of 5. There were no intraneural injections, neurologic sequelae, or complications.

CONCLUSIONS: We suggest that a preoperative nerve block for a sedated patient in the operating room saves time, avoids patient discomfort, augments general anesthesia, provides good postoperative pain control, and has high patient satisfaction with no significant complications.