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Anesthesia for ankle and foot surgery

L Brandt, U Artmeier-Brandt
170 years ago, on 6 October 1846, the dentist William Thomas Green Morton, sucessfully demonstrated ether anesthesia in a patient undergoing surgery in the operating theater of the Massachusetts General Hospital in Boston. He thereby put an end to the unthinkable suffering of patients who had to undergo surgery when fully conscious. Before this "discovery" surgical procedures resembled a battle for life and death. Only a few documents exist illustrating the attitude of surgeons concerning their actions and which tortures patients had to tolerate...
July 15, 2016: Der Anaesthesist
Pravesh S Gadjradj, Maurits W van Tulder, Clemens M F Dirven, Wilco C Peul, B Sanjay Harhangi
OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed...
February 2016: Neurosurgical Focus
Loreto Lollo, Sanjay Bhananker, Agnes Stogicza
BACKGROUND: Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery...
October 2015: International Journal of Critical Illness and Injury Science
Rachel Y Goldstein, Ji Hae Park, Sudheer Jain, Nirmal Tejwani
BACKGROUND: Previous studies have demonstrated the efficacy of popliteal block anesthesia in decreasing post - operative narcotic administration, nausea, and length of stay in patients undergoing foot and ankle surgeries. The purpose of this study was to compare the amount of narcotic medication administered, the need for anti-emetic medica - tion, PACU length of stay, and discharge status in patients treated surgically for ankle fractures who received popliteal blocks with those who received general anesthesia alone...
July 2015: Bulletin of the Hospital for Joint Diseases
Catherine Feuerstein, Lowell Weil, Lowell Scott Weil, Erin E Klein, Nicholas Argerakis, Adam E Fleischer
Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery...
January 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Andrea Veljkovic, Tim Dwyer, Johnny T Lau, Kaniza Zahra Abbas, Peter Salat, Richard Brull
UNLABELLED: Part III of a review series on neurological complications of orthopedic surgery, this article describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common elective foot and ankle procedures for which anesthesiologists may administer regional anesthesia. Relevant information is broadly organized according to type of surgical procedure to facilitate reference by anesthesiologists and members of the anesthesia care team. WHAT'S NEW: As the popularity of regional anesthesia continues to increase with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective foot and ankle procedures...
September 2015: Regional Anesthesia and Pain Medicine
John G Anderson, Donald R Bohay, John D Maskill, Kuldeep P Gadkari, Thomas M Hearty, William Braaksma, Michelle A Padley, Kevin T Weaver
BACKGROUND: A popliteal nerve block is a common analgesic procedure for patients undergoing surgery on their knee, foot, or ankle. This procedure carries less risk in a surgical setting compared with other forms of anesthesia such as a spinal block. Previous reports demonstrated few to no complications with the use of this nerve block, but it is unclear whether these data are consistent with the recent increase in use of this analgesic procedure for lower extremity surgery. METHODS: Retrospectively, a busy orthopedic foot and ankle practice performed a chart review examining for postoperative neuropathic complications possibly related to the popliteal nerve block...
October 2015: Foot & Ankle International
Jacques T YaDeau, Leonardo Paroli, Kara G Fields, Richard L Kahn, Vincent R LaSala, Kethy M Jules-Elysee, David H Kim, Stephen C Haskins, Jacob Hedden, Amanda Goon, Matthew M Roberts, David S Levine
BACKGROUND AND OBJECTIVES: Sciatic nerve block provides analgesia after foot and ankle surgery, but block duration may be insufficient. We hypothesized that perineural dexamethasone and buprenorphine would reduce pain scores at 24 hours. METHODS: Ninety patients received ultrasound-guided sciatic (25 mL 0.25% bupivacaine) and adductor canal (10 mL 0.25% bupivacaine) blockade, with random assignment into 3 groups (30 patients per group): control blocks + intravenous (IV) dexamethasone (4 mg) (control); control blocks + IV buprenorphine (150 μg) + IV dexamethasone (IV buprenorphine); and nerve blocks containing buprenorphine + dexamethasone (perineural)...
July 2015: Regional Anesthesia and Pain Medicine
Chandra H Lloyd, Arjun K Srinath, Ryan D Muchow, Henry J Iwinski, Vishwas R Talwalkar, Janet L Walker, Christopher Montgomery, Todd Milbrandt
BACKGROUND: Peripheral nerve blocks (PNBs) have the potential to reduce postoperative pain. The use of ultrasound (US) to guide PNBs may be more beneficial than nerve stimulation (NS); however, very few studies have studied this technique in children. The objective of this study was to compare postoperative pain control in pediatric patients who had general anesthesia (GA) alone compared with those who had PNB performed by NS, or PNB with both NS and US guidance. Our hypothesis was that compared with NS, the US-guided PNB would result in reduced postoperative pain and opioid use, and that both PNB conditions would have improved outcomes compared with GA...
October 2016: Journal of Pediatric Orthopedics
P T Wu, J S Lee, K C Wu, T T Wu, C J Shao, F W Liang, T C Chern, F C Su, I M Jou
PURPOSE: We evaluated the effects of ultrasound (US)-guided percutaneous radiofrequency thermal lesioning (RTL) and the impact of obesity when treating patients with recalcitrant plantar fasciitis. MATERIALS AND METHODS: 30 consecutive patients were enrolled. The visual analog scale (VAS), American Orthopedic Foot-Ankle Society (AOFAS) Ankle-Hindfoot Score, and plantar fascia thickness measured using US were recorded at baseline and at follow-up 1, 3, 6, and 12 months after surgery under local anesthesia...
February 2016: Ultraschall in der Medizin
Stephen J Head, Rochelle C Leung, Greg P T Hackman, Rachael Seib, Kevin Rondi, Stephan K W Schwarz
PURPOSE: Reliable saphenous nerve blockade is a desirable complement to popliteal sciatic nerve blockade for foot and ankle surgery. We compared two promising ultrasound-guided techniques, the supine adductor canal (AC) technique and the prone peri-saphenous branch of the descending genicular artery (Peri-SBDGA) technique, using 8 mL of 2% lidocaine with epinephrine 1:400,000. METHODS: Following Research Ethics Board approval, we conducted a randomized single-blinded parallel-group trial in 102 patients undergoing foot and ankle surgery at a single centre...
January 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Bilsev Ince, Mehmet Daaci, Zeynep Altuntas, Tugba Sodali, Fatma Bilgen, Mustafa Kursat Evrenos
BACKGROUND AND OBJECTIVE: Reconstructing defects related to the leg soft tissue may be quite difficult because the soft tissue over the bone is rather thin and the tendons lie right under the skin. Distal pedicle sural neurocutaneous flap with its long pedicle composed of skin, subcutaneous tissue and fascia is suitable for superficial defects. This study aimed to determine the usability of the delayed reverse-flow (distally based) islanded sural flap for correcting tibial and ankle defects...
May 2014: Annals of Saudi Medicine
Kyung Tai Lee, Young Uk Park, Hyuk Jegal, Young Tae Roh, Jin Su Kim, Ji Sang Yoon
BACKGROUND: The use of regional anesthesia, such as ankle block or sciatic nerve block, has gained in popularity due to considerations of patient comfort and safety in foot and ankle surgery. However, if the operation extends above the midfoot or if a thigh tourniquet is required, general or spinal anesthesia is needed. The authors aimed to determine by prospective study whether a 'double block', involving femoral and sciatic nerve blocks, is advantageous under such conditions. MATERIALS AND METHODS: The effectiveness of a preoperative double block was prospectively evaluated in 26 consecutive patients undergoing a variety of foot and ankle procedures, compared with 32 patients with sciatic nerve block alone...
July 2014: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Rohit Rahangdale, Mark C Kendall, Robert J McCarthy, Luminita Tureanu, Robert Doty, Adam Weingart, Gildasio S De Oliveira
BACKGROUND: Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics...
May 2014: Anesthesia and Analgesia
Shu-Yuan Li, Peng Zhang, Feng Qu, Jun-Liang Wang, Yu-Jie Liu, Min Wei
OBJECTIVE: To evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy. METHODS: From January 2006 to December 2011, 13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals, ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia, a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity...
May 2013: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Sylvain Isnardon, Marc Vinclair, Celine Genty, Amelie Hebrard, Pierre Albaladejo, Jean-Francois Payen
CONTEXT: Pupillary reflex dilation appears to be a reliable indicator of response to noxious stimulation even under general anaesthesia. The ability of pupillometry to detect the effects of extremity blocks during continuous infusion of opioids remains unknown. OBJECTIVE: To explore the performance of pupillometry to detect differences in pupillary reflex dilation response to a standardised noxious stimulus applied to each leg following unilateral popliteal sciatic nerve block during continuous infusion of remifentanil...
July 2013: European Journal of Anaesthesiology
Vrushali Ponde, Ankit P Desai, Dipal Shah
BACKGROUND AND OBJECTIVES: Arthrogryposis multiplex congenital is hallmarked with immobile joints and muscle fibrosis. The main objective of this study was to compare the success rate of ultrasound-guided sciatic and femoral nerve blocks with nerve stimulations in children diagnosed with distal arthrogryposis multiplex congenita. METHOD: Sixty children aged 8 months to 2 years posted for foot surgery were randomly assigned to group NS and group US of 30 each. Under general anesthesia, femoro-sciatic block was performed with nerve stimulator guidance in group NS and ultrasound guidance in group US...
January 2013: Paediatric Anaesthesia
Ana M López, Xavier Sala-Blanch, Marta Magaldi, Daniel Poggio, Jordi Asuncion, Carlo D Franco
BACKGROUND: Ankle blocks typically include the block of 5 nerves, the 4 branches that trace their origin back to the sciatic nerve plus the saphenous nerve (SaN). The sensory area of the SaN in the foot is variable. Based on our clinical experience, we decided to study the sensory distribution of the SaN in the foot and determine whether the block of this nerve is necessary as a component of an ultrasound-guided ankle block for bunion surgery. METHODS: One hundred patients scheduled for bunion surgery under ankle block were prospectively studied...
September 2012: Regional Anesthesia and Pain Medicine
Kathleen Gartke, Oliver Portner, Monica Taljaard
BACKGROUND: Continuous perineural blocks are increasingly popular for postoperative pain control. While the reported incidence of neuropathic symptoms has been low, the experience of the lead author suggested it may be much higher. The objectives of this study were to elucidate the incidence of patient-reported neuropathic symptoms following continuous popliteal block (CPB) for postoperative pain control in patients undergoing foot and ankle surgery, to characterize these symptoms and to identify preoperative risk factors...
April 2012: Foot & Ankle International
Adrian Jules Macquet, Rosie Jane Christensen, Matthew Debenham, Michael Wyatt, Allan Leslie Panting
BACKGROUND: Where surgery has been preferred, the torn Achilles tendon (AT) has most commonly been repaired under general or spinal anaesthetic (GA). Repair using local anaesthetic (LA) has been reported, but does not appear to be widely used. METHODS: We retrospectively reviewed 87 patients, following open repair using either GA or LA at Nelson Hospital, 2001–2005. Calf strength and ankle range of motion (ROM) were assessed. Subjective pain and function were assessed using the American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire...
September 2011: ANZ Journal of Surgery
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