Introduction: Surgery in the foot and ankle is usually performed under general or spinal anaesthesia. Peripheral nerve blocking is gaining the preference of both surgeons and patients. The aim of this study is to evaluate the adequacy of anaesthesia with the method of triple nerve blocking at the region of the knee.

Materials and methods: One hundred and forty-four patients (79 men and 65 women) that were diagnosed with ankle and foot injuries or diseases underwent surgery using triple nerve blocking at the knee region as a method of anaesthesia. Surgical procedures included bone and soft tissue procedures and especially fracture fixation, osteotomies, tendon repairs, neuroma and tumor excisions, nerve decompressions and arthrodeses. The common peroneal, tibial and saphenous nerves were blocked with injection of 8 ml ropivacaine 2% for each nerve. The injection was performed by an Orthopaedic surgeon with the use of a neurostimulator. An anesthesiologist was available when necessary.

Results: Ninety-four patients tolerated the procedure without the need of additional injection of anaesthesia or analgesia. In 45 patients additional injection of local anesthetic was necessary. Five patients needed intravenous injection of analgesia in order to complete the procedure. Patients were mobilized the day of surgery, reducing in that way hospital stay. Hospitalization ranged from 0 to 1 days with 58 patients discharged the day of the operation. No complication related to the injection of the anestheric was observed.

Conclusion: Triple nerve blocking at the knee, as a method of anaesthesia, is proposed for certain procedures in the foot and ankle; it allows early mobilization of patients and reduces length of hospital stay. If the neurostimulator is used appropriately, the rate of patients that needs additional analgesia intraoperatively is diminished and no adverse effects of the local anestheric are observed. Complications observed with the practice of spinal or general anesthesia are avoided.

Aim: Fixation implants are usually well tolerated by the patients for prolonged periods of time. However, it is not unusual for some patients to develop persistent pain with acute onset that is often combined with paresthesias. The purpose of this study was to verify if the acute onset of pain that is not combined with clinical or laboratory signs of infection could be attributed to an underlying bacterial colonization of implants. Methods: Sixty-four patients (38 male and 26 female) with mean age of 36 years (range, 10 to 73 years) were included in this study. Patients presented with acute onset of pain and/or paresthesias several years after the implantation of stainless-steel þxation materials (plate-screws: 52 and intramedullary nails: 12), in the upper (13) or lower extremity (51). All patients of the present series had negative clinical and laboratory signs of infection. All patients of the present series had their þxation materials removed in our department. The materials subsequently underwent microbiologic and corrosion evaluation. Results: Patients experienced immediate relief after removal of þxation materials. Cultures were positive in 18% of cases and Staph aureus and epidermidis were most frequently encountered. Pseudomonas and enterococcus were also cultured. Conclusions: The percentage of positive cultures (18%) in the patients of our series indicates that symptoms may be due to the bacterial colonization of implants, despite the absence of sings of infection. Although the administration of antibiotics remains controversial, removal of the implants is indicated in cases with acute delayed onset of pain at the site of the implanted þxation materials.