Abstract
Background: Postoperative pain following forefoot surgery can be difficult to control with oral analgesia so regional analgesic methods have become more prominent.
Aim: It is the aim of this study to evaluate the efficacy of a combination of popliteal and ankle blocks and decide if they give significantly better postoperative analgesia than ankle block alone in forefoot surgery.
Methods: This is a prospective, randomised, controlled and single blind study. The total number of patients is 80 with 40 patients in the ankle block only group (control) and 40 patients in the ankle and popliteal block group. All patients underwent forefoot surgery. Postoperative pain was evaluated in the form of a visual analogue scale and verbal response form. Evaluations took place four times for each patient: in the recovery room, 6 hours postoperatively, 24 hours postoperatively and on discharge. The pain assessor, who helped the patient complete the pain evaluation forms, was blinded to the number of blocks used. The amount of opiate analgesia required whilst an inpatient was also recorded. On discharge the patient was asked to rate their satisfaction with the pain experienced during their hospital stay. Results were analysed using Mann-Whitney tests.
Results: Results show that pain is significantly less in recovery (p=0.044) and after 24 hours (p=0.0012) for those patients with combined blocks. Satisfaction with pain relief is also higher for these patients. No complications were found as a consequence of having two peripheral nerve blocks.
Conclusions: A popliteal block in conjunction with an ankle block does reduce postoperative pain significantly more than ankle block alone after forefoot surgery.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
