A randomised controlled trial comparing two popliteal nerve catheter tip positions for postoperative analgesia after day‐case hallux valgus repair

Abstract

We compared the effect of two different positions of a sciatic nerve catheter within the popliteal fossa on local anaesthetic consumption and postoperative analgesia in patients undergoing day-case hallux valgus repair. Eighty-four patients were randomly allocated to receive a sciatic nerve catheter either between the tibial and peroneal components (sciatic group) or medial to the tibial nerve (tibial group). The primary endpoint was postoperative local anaesthetic consumption, while secondary endpoints were pain scores, number of occasions where sleep was disturbed by pain and incidence of insensate limb and foot drop at 24 h and 48 h postoperatively. Postoperative median (IQR [range]) local anaesthetic consumption was 126 (106-146 [98-180]) ml in the sciatic group versus 125 (114-158 [98-200]) ml in the tibial group (p = 0.103). Insensate limb occurred in 14 patients in the sciatic group versus one patient in the tibial group (p < 0.001), while foot drop was reported by six patients in the sciatic group and none in the tibial group (p = 0.012). Sciatic nerve catheter placement medial to the tibial nerve may be a superior analgesic technique for day-case foot surgery.

Lower extremity regional anesthesia: essentials of our current understanding

“…Hauritz et al 222 found that, compared to its out-of-plane (OOP) counterpart, the IP technique was associated with a fourfold increase in catheter dislodgement and 150% greater opioid (morphine) requirements. A recent trial (n=82) compared positioning the catheter tip between the tibial and peroneal nerves or medial to the tibial nerve in the subparaneural space 223. Catheter tip placement medial to the tibial nerve resulted in lower incidences of foot drop (p=0.012) and insensate limb (p<0.001) without impacting overall analgesia and LA consumption 223…”

A Systematic Review of Postoperative Pain Outcome Measurements Utilised in Regional Anesthesia Randomized Controlled Trials

“…The results of the literature search are summarised in Figure 1 . Thirty-one articles met the inclusion criteria and were included in this systematic review [ 12 – 42 ]. A detailed description of the pain outcomes utilised and timings of measurements in the included studies is provided in Table 1 .…”

“…The majority of studies (27/31) utilised two or more pain outcomes. The most commonly used outcome measures were numerical grading of pain/numerical reporting scale (NRS) out of 10 (16 studies) [ 12 , 17 , 20 – 24 , 27 – 29 , 32 – 35 , 38 , 40 ], opioid consumption (16 studies), and visual analogue scale 10 cm (VAS; 12 studies) [ 13 – 16 , 25 , 26 , 31 , 36 , 37 , 39 , 41 , 42 ]. Other than reporting total opioid consumption, analgesia usage was also measured with the following outcomes: nonopioid analgesic requirement [ 14 , 16 , 32 , 33 , 36 ], total supplementary analgesic requirement [ 34 , 35 ], and cumulative opioid consumption [ 26 , 37 ].…”

Pretreatment of ankle nerve block provides better postoperative analgesia than peri‐incisional local anesthetic infiltration in hallux valgus correction surgery

“…However, peripheral nerve blockade has been to play the major role in postoperative multimodal pain regimens . The conventional nerve block techniques for forefoot surgery are popliteal sciatic nerve block or ankle nerve blocks . The technique of popliteal sciatic nerve block has better analgesic effect than subcutaneous infiltration in foot surgery, but popliteal sciatic nerve block may impair immediate postoperative ambulance and is associated with common peroneal nerve damage or residual sensory dysfunction; therefore, blocking the distal braches of the sciatic nerve that provide comprehensive coverage of the area related to HV correction surgery while preserving the motor function of ankle should be considered.…”