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Popliteal regional block anesthesia yields high success rate in foot, ankle surgery
Researchers found no acute complications, and block failure was unrelated to surgery type.
SAN DIEGO – Surgeons and anesthesiologists are increasingly resistant to using popliteal regional block anesthesia in foot and ankle surgery, but a recent study confirms that it is safe and effective in the lower extremities.
Sheeraz Qureshi, MD, MBA, and his colleagues found a 99% success rate in 236 patients who underwent foot and ankle surgery with popliteal regional block anesthesia (PRBA) over a 4-year period.
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“PRBA has been shown in several studies to have a high rate of success and a low rate of long-term complications,” Qureshi said. “However, there is a fear of complications … which has led to a relative resistance because of concerns with block failure, especially when the patient is in the prone position … and the potential for neurologic and vascular complications.”
Qureshi’s comments came during the American Academy of Orthopaedic Surgeons 74th Annual Meeting.
Nerve stimulator technique
Qureshi and his colleagues conducted the IRB-approved, retrospective review of patients treated from October 2002 to May 2006 at the Mount Sinai School of Medicine, a 1,200-bed tertiary-care university-based practice with an anesthesiology residency program, Qureshi said.
The anesthesiologists used the Stimuplex nerve stimulator [B. Braun] and a 21- or 22-gauge insulated needle, Qureshi said.
They performed sterile prep of the thigh and leg of each patient and identified the popliteal fossa, then stimulated <0.4mA of triceps surae, toe extensors and peronei as proof of needle proximity.
Anesthesiologists also used a saphenous nerve block for medial coverage. They injected the anesthetic in 5-cc increments with aspirations in between each increment, Qureshi said.
They injected either 40 cc of 0.5% bupivacaine or 20 cc of 0.5% bupivacaine with 20 cc of 1.5% mepivacaine. But this “was completely based on preference of the anesthesiologist and … the length of the procedure, as well as the amount of postoperative anesthesia required,” Qureshi said.
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99% success rate
At the time of the procedure, patients were an average of 46 years old. Qureshi and his colleagues found that two patients had a block failure, resulting in a 99% success rate.
“Block failure was any reason to convert to general anesthesia when PRBA was the anesthetic of choice,” Qureshi said.
The researchers did not find any association between block failure and type or length of surgery, according to a study abstract.
No patient experienced popliteal artery injury, infection, seizure or cardiopulmonary compromise. “There was one nonacute complication, which was a postoperative neuralgia that developed 2 days after the surgery and resolved without any intervention 7 days postoperatively,” Qureshi said.
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Images: Qureshi S |
For more information:
- Goldstein RY, Kolker D, Qureshi S, et al. The efficacy of popliteal regional block anesthesia in foot and ankle surgery. #66. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.
- Sheeraz Qureshi, MD, MBA, 5th-year resident, Mount Sinai School of Medicine, 5 E. 98 Street, Department of Orthopedics, Box 1188, New York, NY 10029; 917-664-3004; sheerazqureshimd@gmail.com. He has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.