The use of a local anesthetic foot block in patients undergoing outpatient bony forefoot surgery: A prospective randomized controlled trial

Abstract

The os calcis is the most frequently fractured tarsal bone. In 1992 Sanders developed a classification system based on coronal and axial computed tomography (CT) scans of the calcaneus. This classification is the one used most frequently today in treatment decision making and reporting of results. The objective of this study was to assess the degree of interobserver variability in using this classification system. Thirty CTs of calcaneal fractures were chosen randomly from the past 5 years in 2 tertiary care centers. The CTs were reviewed by 3 orthopedic surgeons and one senior orthopedic resident who classified the fractures according to Sanders' classification. The results were first tabulated and analyzed by using a weighted kappa test including the subcategories. The weighted kappa value achieved was.56, with a 95% confidence interval of.45-.67. The subcategories of the classification were then further combined and a second weighted kappa test was performed to assess agreement between general classes. The weighted kappa value achieved was.48, with a 95% confidence interval of 0.37-0.59. We concluded that Sanders' classification system did prove to achieve moderate agreement among users, thus representing a useful classification system.

Peripheral Foot Blockade Versus Popliteal Fossa Nerve Block: A Prospective Randomized Trial in 51 Patients

“…Consequently, it provides for adequate postoperative analgesia, which is required for outpatient surgical procedures. In a prospective, randomized controlled study, Clough et al (11) reported a mean 12 hours before patients reported first pain. They concluded that although the foot block prolongs the time to first-perceived pain, it does not improve patient satisfaction.…”

The Effects of Timing of Ankle Blocks in Forefoot, Midfoot, or Hindfoot Reconstruction With the Use of an Ankle Tourniquet

“…9-12 The administration of an ankle block in the ambulatory surgery setting is an essential step in providing appropriate pain management in the postoperative period. 1-4,7,13 Ankle blockade inhibits neural conduction from the surgical site to the spinal cord and is an established and successful form of MDA. 9,11 Clough et al 2 in a randomized controlled clinical trial found that adding foot block to general anesthesia for forefoot surgery yielded a significantly longer time to first perceived pain.…”

“…1-4,7,13 Ankle blockade inhibits neural conduction from the surgical site to the spinal cord and is an established and successful form of MDA. 9,11 Clough et al 2 in a randomized controlled clinical trial found that adding foot block to general anesthesia for forefoot surgery yielded a significantly longer time to first perceived pain. The supplementary use of local infiltration around the surgical wound is a reproducible and low-cost technique for postoperative anesthesia.…”

“…Ankle blocks are a form of MDA that assist in the management of postoperative pain and can circumvent its negative effects. 1,2,9 Although evidence exists to support performing an ankle block after tourniquet inflation for postoperative pain control in foot surgery, there is no current standard for practice. 7 In our study, we did not find the timing of an ankle block in relation to tourniquet inflation to have an effect on postoperative pain or narcotic consumption.…”

“…Peripheral regional anesthesia, a type of multimodal drug anesthesia (MDA), is performed in many ambulatory surgical settings to provide optimal pain control in the postoperative period. 1-7 In a survey of 5703 patients undergoing ambulatory surgery, procedures involving the foot and ankle were considered to be one of the most painful, with 55% of patients experiencing some degree of pain at home. 5 An ankle block is a type of peripheral regional anesthesia that is practical and successful in greater than 90% of surgical cases.…”