Abstract
Background
Post-operative pain following forefoot surgery can be difficult to control with oral analgesia so regional analgesic methods have become more prominent in foot and ankle surgery. It was the aim of this study to evaluate the efficacy of a combination of popliteal and ankle blocks and decide if they provide significantly better post-operative analgesia than ankle block alone in forefoot surgery.
Methods
This was a prospective, randomised, controlled and single blind study. The total number of patients was 63, with 37 in ankle block only group (control) and 26 in ankle and popliteal blocks group. All patients underwent forefoot surgery. Post-operative 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 post-operatively, 24 hours post-operatively 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 as 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 after 6 and 24 hours and on discharge for those patients with combined blocks. Satisfaction with pain relief is also higher for these patients. Significantly less oral codeine pain relief is also required.
Conclusion
A popliteal block in conjunction with an ankle block does reduce post-operative pain significantly more than ankle block alone after forefoot surgery.
