Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Traditionally, in our hospital, forefoot interventions have been performed by ultrasound-guided locoregional anesthesia, as a sciatic-popliteal neural block, combined with transartorial saphenous internal block. The purpose of the saphenous block is to avoid the discomfort derived from the use of the ischemia cuff that is placed above the ankle. And it is precisely the need for this blockade that we question in this work.

Methods We selected a group of 50 patients from those who were going to undergo forefoot surgery. All of them underwent anxiolysis with Midazolam 7.5mg (pre-block), and Midazolam 1mg IV + Fentanyl 50mcg IV (post-block). Only the sciatic-popliteal was performed, warning them of the possibility of discomfort in relation to the ischemia cuff, and that they should notify us in case they perceived this discomfort, so that we could correct it. Precaution was taken to place the ischemia cuff as distal as possible. We counted the number of patients who required IV analgesic rescue to finish the intervention comfortably.

Results Only 7 required IV rescue, due to discomfort derived from the ischemia cuff. In addition, 2 patients also needed it, but it was due to failure of the sciatic-popliteal block.

Conclusions It seems reasonable to question the need for saphenous block in this type of surgical intervention, since most patients do not seem to need it. 1. Absence of discomfort for the patient of the second puncture. 2. Minimization of the potential risk of iatrogenesis 3. Shorter time to perform the anesthetic technique. 4. Economic savings.