Abstract
Background: Local blocks, as the sole means of anaesthesia, in forefoot surgery have previously been described. This technique is not widely practised in the UK but we have routinely used such blocks for many years. Our aim was to assess how well patients tolerated this technique.
Methods: 64 consecutive day cases of fore-foot surgery were recruited prospectively for local anaesthetic block. A range of operations were performed including basal osteotomy of 1st metatarsal and MTPJ arthrodesis. No patients declined to be included. Peripheral nerve blockade was performed by the orthopaedic surgeon or his registrar. Efficacy of block was assessed intra-operatively with a visual analogue score (VAS) of 0 to 10 (10 being worst pain imaginable and 0 being no pain). Overall satisfaction with the anaesthetic procedure was assessed on a 5 point scale (from 1 = very unsatisfied to 5 = very satisfied) at 2 weeks.
Results: Average time to perform the block was 6 minutes (range 3 to 12 mins). Mean VAS for knife to skin was 0.38 (95% confidence ± 0.31) and for ankle tourniquet was 1.44 (95% confidence ± 0.51). At follow up mean satisfaction at 2 weeks was 4.2 out of 5 (95% confidence ± 0.30) with only 9 patients lost to follow up (86% of patients followed up). No complications were reported.
Conclusion: Our experience is that these blocks are quick and easy to perform in the hands of orthopaedic surgeons. They are well tolerated and effective. They result in a considerable cost saving in terms of theatre efficiency and anaesthetist and ODP resources. These savings are still being evaluated.
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Author: Richard Freeman, United Kingdom
E-mail: richardfreeman@doctors.net.uk
