Ankle block anesthesia and ankle tourniquets for foot and ankle surgery

Abstract

Most foot and some ankle surgery is performed in the ambulatory surgery setting. A combination of regional ankle block anesthesia and an ankle tourniquet has several advantages over spinal or general anesthesia and the use of a thigh tourniquet. The ability to anesthetize only the foot and ankle allows for decreased morbidity, increased patient comfort level, and more rapid postoperative recovery. The ankle tourniquet eliminates unnecessary ischemia of the entire lower leg and has not been associated with the high incidence of tourniquet pain that occurs with the thigh tourniquet. It was initially theorized that an ankle tourniquet would cause pressure-induced neural damage. However, the physiological and clinical evidence shows that the ankle tourniquet causes reversible ischemia of the peripheral nerves, which is safe and well-tolerated by the patients. Both the pneumatic tourniquet and Esmarch bandage can be effectively used as an ankle tourniquet. The use of these techniques for a variety of foot and ankle procedures has been highly successful.