Ultrasound Guided Popliteal Nerve Block For Various Ankle & Foot Surgeries

Authors

  • Dipti Anandani (Assistant professor of Anaesthesia, NHLM Medical college, Ahmedabad, Gujarat)
  • Manisha Kapdi (presently Associate professor of Anaesthesia, AMCMET Medical college, Ahmedabad, Gujarat, Ex-Associate professor of Anaesthesia NHLM Medical college Ahmedabad Gujarat.)
  • Bhakti Rajani (Ex Resident of Anaesthesia, NHLM Medical college, Ahmedabad, Gujarat)

DOI:

https://doi.org/10.48165/ijabms.2021.233704

Keywords:

Ankle & Foot surgeries, popliteal nerve block, Ultrasound guidance

Abstract

Background: Ankle& foot surgeries are very common surgeries in various age groups like  young & geriatric as well as in patients with comorbidities. Popliteal nerve block is one of  multimodal Anaesthesia & analgesia for same. we have used ultrasound guided block to  prevent complications &precise volume at a site for improving Characteristics of block. Aims of study: To study the technique of giving popliteal nerve blocks with ultrasonographic guidance and  evaluate it in terms of: No of attempts, Time required for sensory and motor blockade, Quality of Intra operative  analgesia, Duration for post-operative analgesia, Supplementation required in form of sedo  analgesia/general anaesthesia & Complications encountered. Methods: We performed ultrasonography guided popliteal nerve block in 60 adult patients of  ASA grade I/II/III undergoing foot and ankle surgeries. The volume of drug used was 20ml consisting of Lignocaine (1.5%) 10ml and Bupivacaine (0.5%) 10ml; Results: The mean time taken to conduct the block was 4.3±1.4 mins. The mean time taken for sensory  onset was 3.8±1.1 mins. The mean time taken for motor onset was 7.0± 1.4 mins. The mean  time taken for completing the surgery was 39.2±5.0 mins. The mean time taken for complete  motor regression was 143.8±13.5 mins. The mean time taken for complete sensory  regression was 184.8± 16.8 mins. The patients first complained of pain at the mean time of  239±22.4 mins. The patients have stable haemodynamic parameters: pulse rate, SBP, DBP throughout the  operation. Failure of block was seen in 4 patients where supplementation in the form of  Injection Midazolam 1mg IV and Injection Fentanyl 50microgm IV was given in 2 patients  and general anaesthesia was given in 2 patients. No other neurological complications were  noticed in our study. Conclusion: ultrasound guided Popliteal nerve block is safe& effective block for various ankle &foot surgeries.

References

Adam Aubuchon, W. David Arnold and J. Chad Hoyle (2017)

Adibatti M, Sangeetha V. Study on variant anatomy of sciatic nerve. J Clin Diagn Res. 2014;8:AC07-AC09.

Adriani J. Labatt’s Regional Anesthesia. Techniques and Clinical Applications., W.B. Saunders Company, Philadelphia, pp 317-21, 1967.

Baskin JL, Baxter, DE: Regional anesthesia for ambulatory foot and ankle surgery. Orthopedics 10:109, 1987

Brown, DL: Popliteal Block, in Atlas of Regional Anesthesia, ed by DL Brown, WB Saunders, Philadelphia, p 109, 1992.

Brull R, Macfarlane AJR, Parrington S, et al. Is circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block? a proof-of-concept study. Reg Anesth Pain Med. 2011;36(30):266-270.

Canales MB, Huntley H, Reiner M. Ehredt DJ, Razzante M (2015) The popliteal nerve block In Foot and Ankle Surgery: an Efficient and Anatomical Technique. J Anesth Clin Res 6:553. Doi:10.4172/2155-6148.1000553.

Carty S, Nicholls B, Ultrasound-guided regional anaesthesia, Contin Educ Anaesth Crit Care Pain (2007) 7 (1):20-24

Chan VW, Nova H, Abbas S, et al. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology 2006; 104: 309 14.

Creech C, Meyr AJ (2013) Techniques of popliteal nerve regional anesthesia. J Foot Ankle Surg 52: 681-685.

Danelli G, Fanelli A, Ghisi D, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia. 2009;64(6):638-642.

Dufour E, Quennesson P, Van Robais AL, Ledon F, Laloe PA, et al. (2008) Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anaesth Analog 106:1553-1558, table of contents.

Gallardo J, Lagos L, Bastias C, Henríquez H, Carcuro G, et al. (2012) Continuous popliteal block for postoperative analgesia in total ankle arthroplasty. Foot Ankle Int 33: 208-212.

Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, et al (2011). Analgesic efficacy of ultrasound-guided regional anaesthesia: a meta-analysis. J clin Anesth 23:90-96.

Gray H. Grays Anatomy of the Human Body 20th ed. (1918). New York, NY: Bartleby; 2000.

Guntz E, Herman P, Debizet E, Delhaye D, Coulic V, et al. (2004) Sciatic nerve block in the popliteal fossa: description of a new medial approach. Can J Anaesth 51: 817-820

HadzicA, Vloka JD (1998) A comparison of the posterior versus lateral approaches to the block of the sciatic nerve in the popliteal fossa. Anesthesiology 88: 1480-1486.

Hajek V, Dussart C, Klack F, Lamy A, Martinez JY, et al. (2012) Neuropathic complications after 157 procedures of continuous popliteal nerve block for hallux valgus surgery. A retrospective study. Orthop Traumatol Surg Res 98: 327-333.

Hansen E, Eshelman MR, Cracchiolo A 3rd (2000) Popliteal fossa neural blockade as the sole anesthetic technique for outpatient foot and ankle surgery. Foot Ankle Int 21: 38-44.

Hegewald K, McCann K, Elizaga A, Hutchinson BL (2014) Popliteal blocks for foot and ankle surgery: success rate and contributing factors. J Foot Ankle Surg 53: 176-178.

Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand.2008 Jul; 52(6): 727-37.doi:10.1111/j.1399-6576.2008. 01666.x. E pub 2008 May 12. Review

Lee JH, Lee BN, Lee My, An X, Han SH (2013) The significance of tibial and common peroneal nerves in nerve blocks. Surg Radial Anat 35:211-215

Malouf D, Liu SS, Movahedi R, Goytizolo E, Memtsoudis SG, et al. (2012) Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery. J Clin Anesth

: 44-50. 24. Marhofer P, Grehner M, Kapral S. Br. J. Anaesth. (2005) 94 (1): 7-17.doi: 10.1093/bja/aei002.

Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, et al. (2009) Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med 34: 480-485.

Miller S.J. D.P.M. Chapter 43: Use of popliteal Blocks in Foot and Ankle surgery, p 220223, 2001.

Miller, Ronald D. (November 2, 2006). Basics of Anesthesia. Churchill Livingstone.

Moore KL, Agur AM. Essential Clinical Anatomy. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2002

Moore, Clinically Oriented Anatomy, 6th edition.

Neal Joseph M et al (2016). Regional Anesthesia & Pain Medicine: March/April 2016 - Volume 41 - Issue 2 - p181 194 doi: 10.1097/AAP.0000000000000331

Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, et al. (2008) Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med 33: 259-265.

Phillips WJ, Troutman G, Lerant A (2011) Nerve stimulator-assisted sciatic nerve block for painful procedures in the ED. Am J Emerg Med 29: 1130-1135.

Provenzano DA, Viscusi ER, Adams, SBJr, Kerner, M, Abidi NA. The safety and efficacy of the popliteal fossa nerve block for foot and ankle surgery. American Orthopedic Foot and Ankle Society 31st Annual Meeting, San Francisco, CA, March 2001.

Rodríguez J, Taboada M, Carceller J, Lagunilla J, Bárcena M, et al. (2006) Stimulating popliteal catheters for postoperative analgesia after hallux valgus repair. Anesth Analg 102: 258-262.

Rogobete AF, Bedreag OH, Sarandan M, Papurica M, Preda G, et al. (2015) Liposomal bupivacaine - new trends in Anesthesia and Intensive Care Units. Egyptian Journal of Anaesthesia 31: 89-95.

Rorie DK, Byer DE, Nelson DO, et al: Assessment of block of the sciatic nerve in the popliteal fossa. Anesth Analg 59:371-6, 1980.

Saleh HAM, El-fark MMO, Abdel-Hamid GA. Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade. Folia Morphol. 2009;68: 256-259.

Salinas FV Evidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block: Update 2016 Regional Anesthesia & Pain Medicine 2016; 41:261-274.

Schimek F, Deusch H: New technique of sciatic nerve block in the popliteal fossa. Eur J Anaesth 12:163-169, 1995.

Sites, Brian D.; Chan, Vincent W.; Neal, Joseph M.; Weller, Robert; Grau, Thomas MD; Koscielniak-Nielsen, Zbigniew J.; Ivani, Giorgio. The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in UltrasoundGuided Regional Anesthesia, Regional Anesthesia and Pain Medicine, Volume 34, issue 1, January-February 2009:40-46.

Southerland JT, Boberg JS, Downey MS, Nakra A (2009). The Podiatry Institute, Southerland JT, Boberg JS, Downey MS, Nakra A (2009) Local Anesthetics: McGlamery’s Comprehensive Textbook of Foot and Ankle Surgery. (4thedn), Lippincott Williams & Wilkins, Philadelphia.

Taboda, Muniza M, a Lvarez J, cortes, Atanasoff PG (2003) Lateral approach to the sciatic nerve block in the popliteal fossa: correlation between evoked motor response and sensory block. Reg Anesth Pain Med 28:450-455.

Techasuk, Wallaya et.al. Regional Anesthesia & Pain Medicine: March/April 2014 - Volume 39 - Issue 2 p 108 111 doi: 10.1097/ AAP.0000000000000051.

Tomaszewski KA, Graves MJ, Henry BM, et al. Surgical anatomy of the sciatic nerve: a meta-analysis. J Orthop Res. 2016; 34:1820-1827.

Van Geffen GJ, van den Broek E, Braak GJ, Giele JL, Gielen MJ, et al. (2009) A prospective randomized controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesth Intensive Care 37: 32-37.

WHO Model List of Essential Medicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014

Zetlaoui PJ, Bouaziz H (1998) Lateral approach to the sciatic nerve in the popliteal fossa. Anesth Analg 87: 79-82.

Published

2021-08-25

How to Cite

Ultrasound Guided Popliteal Nerve Block For Various Ankle & Foot Surgeries. (2021). Indian Journal of Applied-Basic Medical Sciences, 23(37), 39–57. https://doi.org/10.48165/ijabms.2021.233704