Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery

Abstract

Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.

The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery

“…12,17 The present study is the first to estimate the size of the effect of saphenous nerve block after major ankle surgery.…”

“…Not only does the pain arise immediately after surgery, it also seems to persist for a long time. 12,17 The results from our previous saphenous nerve block study indicate that the saphenous pain persists for longer than the duration of a single-injection with bupivacaine-epinephrine and that prolongation of the block duration with adjuvant perineural dexamethasone can reduce opioid consumption during the first 24 hours. 12 The focus on adequate postoperative pain management is important, and clinical studies have shown that early postoperative pain is a strong risk factor in developing chronic pain after surgery.…”

“…12,17 The results from our previous saphenous nerve block study indicate that the saphenous pain persists for longer than the duration of a single-injection with bupivacaine-epinephrine and that prolongation of the block duration with adjuvant perineural dexamethasone can reduce opioid consumption during the first 24 hours. 12 The focus on adequate postoperative pain management is important, and clinical studies have shown that early postoperative pain is a strong risk factor in developing chronic pain after surgery. 10,18,19 A saphenous nerve block proximal to the apex of the femoral triangle is a very effective way of alleviating the pain from the saphenous nerve territory.…”

“…However, that trial was bupivacaine controlled and not placebo controlled. 12 Consequently, we do not know if the saphenous nerve causes significant clinical pain after major ankle surgery, and the magnitude of the effect of the saphenous nerve block has never been established.…”

Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review

“…All studies but one 31 were conducted in Europe. [26][27][28][29][30]32 Sample size ranged from 30 to 98 participants, most of whom underwent arthrodesis, calcaneal osteotomy or ankle replacement procedures. The average age of participants ranged from 39 to 62 yr old across trials.…”