Article Text
PDF
Abstract
Background and aims There is good evidence to support the use of continuous popliteal nerve block (CPNB) for foot and ankle surgery (FAS). Our institution routinely uses this technique for both day-case and inpatient procedures. This 12-month retrospective analysis compares the analgesic efficacy of CPNB with conventional single shot popliteal nerve block (SSPNB).
Methods Retrospective review of electronic case notes of patients undergoing elective FAS in a large teaching hospital. Ethical approval was not required for service evaluation project.
Results 98 case notes were examined in the studied period (Chart 2). 17% received CPNB and 33% received SSPNB (± supplemental block). Within the CPNB subgroup, only 24% required IV opioids in recovery compared with 33% in the SSPNB group. 24h breakthrough opioid requirement was also reduced in the CPNB subgroup compared with SSPNB subgroup (29% vs 50%, respectively, Chart 1). There were no safety issues associated with CPNB during the studied period. RA technique was influenced by surgical procedure, with CPNB more likely to be offered for extensive ankle and hindfoot surgical procedures. Mean stay in the CPNB subgroup was 1.47 days (range 1–4) and 1.32 days for the SSPNB subgroup (range 0–5).
Chart 2. Type of surgery and regional anaesthesia technique
Chart 1. Comparison of IV Opiods requirment in immediate post operative period and break throught strong opioids in first 24h after surgery
Conclusions CPNB is a safe and effective technique for intra- and post-operative pain management in FAS. Our review demonstrated reduced opioid requirements in the immediate recovery period, as well as a reduction in 24h breakthrough opioid requirement, despite CPNB typically being used in more extensive procedures.