POPLITEAL NERVE BLOCK FOR HINDFOOT SURGERY IN A DISTRICT GENERAL HOSPITAL SETTING

Abstract

Background: Postoperative pain following hindfoot surgery can be difficult to control with opioid analgesics. Popliteal nerve blocks have been shown in the literature to be effective in both delaying the onset of postoperative pain and reducing the intensity of the pain, with a variable duration of effect. In 2007 we established a ‘block team’ of anaesthetists available to administer popliteal blocks preoperatively.

Methods: Forty-nine consecutive patients undergoing hindfoot surgery were selected. Data was collected: The proportion of patients having a block; opiate requirement during surgery, in the recovery room and on the ward; pain score; time to mobilize after surgery; and length of stay.

We compared two techniques used for popliteal block and also compared post-operative pain control with and without a popliteal block.

Results: There was a considerable increase in the percentage of patients who had a popliteal block after the block team was established (40% to 91%). Six of 23 (23%) patients needed opiates in the recovery room in the nerve block group; compared to12 of 20 (60%) patients who did not have a block. Comparing the two techniques used for the nerve block, ultrasound guidance reduced postoperative intravenous opiate usage compared to blocks given with the aid of a nerve stimulator (p< 0.05). Fifteen of 16 (94%) patients mobilized on the first post operative day in the ultrasound group compared to 16 of 23 (64%) in the patients who had no block. There were no complications recorded as a result of popliteal nerve blocks.

Conclusions: Establishing a block team has improved the proportion of patients receiving a popliteal block in hindfoot surgery in our hospital. The ultrasound guided technique gives superior results in terms of pain relief and earlier mobilization, when compared blocks administered using a nerve stimulator.