Postoperative sciatic and femoral or saphenous nerve blockade for lower extremity surgery in anesthetized adults

Abstract

Background:Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery.Materials and Methods:Postoperative patients administered general anesthesia received popliteal sciatic nerve blockade and either femoral or saphenous nerve blockade if operative procedures included medial incisions. Nerve blocks were placed with nerve stimulator or ultrasound guidance. A continuous nerve catheter was inserted if hospital admission was over 24 hours. Opioid analgesic supplementation was administered for inadequate pain relief. Postoperative pain scores and total analgesic requirements for 24 hours were recorded. Nerve block related complications were monitored for during the hospital admission and at follow up surgical clinic evaluation.Results:190 anesthetized adult patients were administered 357 nerve blocks. No major nerve injury or deficit was reported. One patient had numbness in the toes not ascribed to a specific nerve of the lower extremity. Perioperative opioid dose differences were noted between male and female and between opioid naïve and tolerant patients.

Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

“…In the present study, none of the patients exhibited motor blockade. Lollo et al [7] demonstrated a similar standard that all patients should be able to perform toe plantar flexion immediately and after 24 hours postoperatively. The importance of any clinical study is based on patient satisfaction, and in this study, there was showed no statistical difference in PSS in the three groups at 24 and 48 hours postoperatively.…”

“…Use of combined femoral and sciatic blocks offer a practical alternative to epidural analgesia for unilateral knee replacements [6]. Lollo et al [7] reported no major nerve injury or deficit among 357 popliteal sciatic nerve blocks with either femoral or saphenous nerve blocks performed. YaDeau et al [8] compared ultrasound-guided sciatic and adductor canal blocks (ACB) with intravenous (IV) dexamethasone and/or buprenorphine, and found there was no difference in pain with movement at 24 hours.…”

“…The authors did not administer the sciatic popliteal block (SPB), used a different dose of dexmedetomidine and did not perform any postoperative follow-up [11]. The published literature describes use of ACB and SPB for postoperative analgesia in lower limb surgery patients [6][7][8].…”

Nerve injury following popliteal nerve and adductor canal blocks: A case series

“…Past literature reports minimal risk and low complication rates of peripheral nerve blocks in studies with large sample sizes (10,12).…”

“…Provenzano et al did not report any complications affiliated with peripheral nerve blocks in a group of 467 patients that underwent foot and ankle surgery (6). Similarly, Lolo et al did not report any major nerve injury or deficit after the administration of 357 nerve blocks in the lower extremity (12). Meanwhile, Anderson et al reported a cohort of 1014 patients where 52 patients (5%) had neuropathic symptoms postoperatively likely related to popliteal block, excluding patients with complex regional pain syndrome and neurologic-symptoms related to procedure (5).…”