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B96 Awake foot surgery using a combined popliteal sciatic and selective ankle nerve block for ambulatory care
  1. S Diwakar1,
  2. K Stewart1,
  3. D Wilson1 and
  4. B Manickam2
  1. 1University Hospital of North Tees, Stockton-on-tees, UK
  2. 2County Durham and Darlington NHS Foundation Trust, Darlington, UK


Background and Aims Awake ankle surgery performed solely under peripheral nerve block has proved challenging due to poor tolerance of tourniquet and prolonged onset time for surgical anaesthesia, often requiring additional spinal or general anaesthesia, resulting in delayed mobilisation.

We aim to evaluate a combined regional anaesthetic technique including popliteal sciatic block using a short-acting local anaesthetic (LA) with a selective ankle block using a long-acting LA, to overcome the disadvantages of using either of them on its own.

Methods Patients undergoing foot surgery underwent popliteal-sciatic blocks using 10–15 ml of 2% lignocaine followed by selective ankle blocks using 10–15 ml of 0.75% ropivacaine with ultrasound guidance.

Results Surgical anaesthesia was achieved, with no requirement of additional analgesia, sedation or conversion to general anaesthesia in 100% of cases (n=19). Mean block-to-surgical-anaesthesia time was 11.89 minutes with a mean anaesthetic procedural time of 12.63 minutes. Mean volumes of 2% lignocaine and 0.75% ropivacaine used were 11.94 and 14.57 mL respectively. There were no reported instances of tourniquet or surgical pain and patient satisfaction was good. Mean surgical time was 51 minutes (range 40–75 minutes). Mean foot-drop duration was 155 minutes (range 120–210 minutes).

Conclusions This audit demonstrates that a combined regional anaesthetic technique, provides rapid onset of surgical anaesthesia for foot surgery while not being prohibitive to list efficiency. It further reveals that this is a reliable method for the reduction in the peri-operative use of sedatives and analgesic drugs while facilitating ambulatory surgery.

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