Regional Anesthesia for Foot and Ankle Surgery

Abstract

We present our experience with the use of regional anesthesia in 1295 of 1862 (69.5%) surgical procedures of the foot and ankle between 1986 and 1989. Regional anesthesia was used for surgical procedures of the forefoot, midfoot, hindfoot, and ankle in the setting of elective surgery and trauma. From the viewpoint of the surgeon, regional anesthesia was completely successful in 95% of the procedures performed. Sample patient surveys confirmed that 87% of patients were satisfied with the use of regional anesthesia for their operative procedure. There were four (0.3%) minor complications, one being lidocaine toxicity. With increasing experience, the expanded indications and uses of regional anesthesia for foot and ankle surgery are proving to be simple, safe, reliable, and well tolerated by the patient.

Easily identifiable bony landmarks as an aid in targeted regional ankle blockade

“…The tibial artery is palpated and the needle slowly advanced posterior to the artery, perpendicular to the medial malleolus, piercing the flexor retinaculum (Giachino, 1988;Raj, 1991). Unintentional intravascular injection should be avoided by aspirating before injection (Beskin and Baxter, 1987;Myerson et al, 1992). Murphy (1988) suggests a method where the needle is advanced towards the pulse of the posterior tibial artery.…”

“…Various methods for an ankle blockade are found in the literature (Schurman, 1976;Kofoed, 1982;Sarrafian et al, 1983;Sharrock et al, 1986;Bridenbaugh, 1988;Giachino, 1988;Murphy, 1988;Hoerster, 1990;Raj, 1991;Lichtenfeld, 1992;Myerson et al, 1992;Ferrera and Chandler, 1994).…”

“…Foot surgery is also being increasingly performed as an outpatient procedure where regional anesthesia of the foot has the potential and advantage of decreased morbidity and mortality, and a greater comfort level to the patient with the absence of postanesthetic complications and a more rapid recovery compared with spinal or general anesthesia (McCutcheon, 1965;Bridenbaugh, 1969;Schurman, 1976;Beskin and Baxter, 1987;Giachino, 1988;Lichtenfeld, 1992;Myerson et al, 1992;Singelyn, 2002). The ankle block is therefore ideally suited to be performed for regional anesthesia for ambulatory foot surgery (McCutcheon, 1965;Bridenbaugh, 1969;Beskin and Baxter, 1987), i.e., incision and drainage of an abscess, suture of a laceration, toe nail avulsion, removal of a foreign body, excision of a plantar wart, and toe amputation (McCutcheon, 1965).…”

Foot and Ankle Surgery: Considerations for the Geriatric Patient

“…These procedures are usually performed under intravenous sedation (monitored anesthesia care) with regional local blocks (marcaine/lidocaine) in an outpatient setting 39,40 ( Figure 5). Most patients are treated with a postoperative weight-bearing shoe or a temporary non-weight-bearing splint, which is eventually switched to a walking boot.…”

Untitled

“…Anatomical studies of the TN in the distal third of the leg and at the level ankle began to take more importance with the establishment and definition of course of the TN due to the wide clinical and research purposes of the TN and development of minimally invasive treatment of bladder dysfunction such as Percutaneous Tibial nerve stimulation (PTNS), nerve block and etc. [1,2]. We determined, through dissection of fresh cadaver, the neuroanatomy of the TN and its relation to the other structures at the ankle in relation to the tarsal tunnel.…”