The efficacy and safety of continuous versus single-injection popliteal sciatic nerve block in outpatient foot and ankle surgery: a systematic review and meta-analysis

Abstract

Background Continuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. Its efficacy as well as safety is yet to be established. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB. Methods We performed a comprehensive literature review on Web of Science, the Cochrane Library, PubMed and Embase and only included randomized controlled trials (RCTs). Five RCTs that compared the efficacy and safety of CPSNB with the single-injection popliteal sciatic nerve block group were included. The primary outcome parameters were visual analog scale (VAS) scores at postoperative 24, 48 and 72 h. The secondary outcome parameters were amount of oral analgesics consumed, overall patient satisfaction and need of admission after surgery. A sensitivity analysis was performed to explore the consistency of the results. Results In comparison with the single-injection group, CPSNB was associated with a lower VAS score at postoperative 24 and 48 h (p < 0.05). There were no neuropathic symptoms or infection events after the nerve block. However, there were several minor complications associated with the pump and catheter system, with drug leakage being the most common complication (N = 26 of 187, 13.9%). Conclusion CPSNB is an effective method in pain management for outpatient foot and ankle surgery. Both methods appear to be safe as none of the patients experienced neuropathic symptoms or infection. Further studies with larger sample size are needed to compare the risk of major complications between the two methods. Level of evidence I; meta-analysis.

Impact of Self-Coiling Catheters for Continuous Popliteal Sciatic Block on Postoperative Pain Level and Dislocation Rate: A Randomized Controlled Trial

“…This is comparable with the leaking rate of 31 % for CTN technique in another study [40]. Lower leakage rates of 13.9 % for continuous distal sciatic catheters were reported [44]. Leakage problems commonly occur with catheter-through-needle approaches, because needle´s diameter is larger than the catheter.…”

“…In this study, catheter occlusion occurred in one patient from each cohort (total 1.4 %). Ma et al reported this rare incident with a rate of 1 % [44].…”

Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

“…The safety and effectiveness of the PB in the foot and ankle surgery have been well established in the literature [ 2 , 17 , 18 , 24 ]. US-guided technique enhances PB’s success rate since the sciatic nerve can be well visualized throughout the entire injection process in real-time [ 25 ].…”

“…The shortcomings of DB included pain associated with injection and the likelihood of multiple injections in some cases. The advantages of PB included safety and effectiveness in various other foot and ankle surgeries, as well as less pain associated with injections from patient experience [ 2 , 17 , 18 , 19 ]. The shortcomings of PB included the broader area of anesthesia, longer duration before wearing off, and not quite common use in the ingrown toenail.…”

Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery

“…Foot and ankle surgery is often associated with postoperative opioid use which has been demonstrated to be associated with several postoperative complications [ 1 ]. Continuous peripheral nerve blocks (CPNB) are a safe and effective method in pain management for outpatient foot and ankle surgery [ 2 ]. CPNBs have also been shown to reduce the requirement of rescue opioid use following ambulatory orthopedic surgery in comparison to single-shot peripheral nerve blocks (PNB) [ 3 ].…”