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Anesthesia for ankle and foot surgery

Ashraf Elsayed Alzeftawy, Nabil Aly Elsheikh
BACKGROUND: Peripheral nerve blocks have become an increasingly popular form of anesthesia. Preemptive analgesia reduces central sensitization, postoperative pain, and analgesic consumption. Different additive has been used to prolong regional blockade and improve postoperative analgesia. AIM: This study was conducted to evaluate whether preemptive ankle block using combination of ropivacaine and dexamethasone would succeed in improving the postoperative analgesia after foot surgery in patients receiving general anesthesia...
April 2017: Anesthesia, Essays and Researches
D Yao, E Jakubowitz, S Ettinger, C Plaass, C Stukenborg-Colsman, K Daniilidis
OBJECTIVE: Gait improvement by restoring dorsiflexion using a neuroprosthesis implant. INDICATIONS: Foot drop with damage to the 1st motor neuron; passive mobility in ankle is possible; adult patients. CONTRAINDICATIONS: Foot drop with peripheral damage and injury to the peroneal nerve; already implanted stimulators (e.g., defibrillator, pacemaker, or pain stimulator); severe anesthesia risks in multimorbid patients. SURGICAL TECHNIQUE: Surgery in lateral position...
May 4, 2017: Operative Orthopädie und Traumatologie
Shaylyn H Montgomery, Colleen M Shamji, Grace S Yi, Cynthia H Yarnold, Stephen J Head, Scott C Bell, Stephan K W Schwarz
BACKGROUND AND OBJECTIVES: Ultrasound-guided subsartorial saphenous nerve block is commonly used to provide complete surgical anesthesia of the foot and ankle in combination with a popliteal sciatic nerve block. However, in part owing to its small caliber and absence of a prominent vascular landmark in the subsartorial plane distal to the adductor canal, the saphenous nerve is more difficult to reliably block than the sciatic nerve in the popliteal fossa. Although the saphenous nerve is a sensory nerve only, neurostimulation can be used to elicit a "tapping" sensation on the anteromedial aspect of the lower leg extending toward the medial malleolus...
January 2017: Regional Anesthesia and Pain Medicine
Ulrich Rother, Werner Lang, Raymund E Horch, Ingo Ludolph, Alexander Meyer, Susanne Regus
BACKGROUND: Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography. METHODS: Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford IV-VI) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index...
April 2017: Annals of Vascular 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...
October 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
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