The efficacy and safety of continuous versus single-injection popliteal sciatic nerve block in outpatient foot and ankle surgery: a systematic review and meta-analysis

Hsuan-Hsiao Ma,Te-Feng Arthur Chou,Wei-Ming Chen,Cheng-Fong Chen,Po-Kuei Wu,Shang-Wen Tsai

doi:10.1186/s12891-019-2822-7

Hsuan-Hsiao Ma, Te-Feng Arthur Chou + Show 4 more

Open Access

https://doi.org/10.1186/s12891-019-2822-7

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Abstract

BackgroundContinuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. Its efficacy as well as safety is yet to be established. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB.MethodsWe performed a comprehensive literature review on Web of Science, the Cochrane Library, PubMed and Embase and only included randomized controlled trials (RCTs). Five RCTs that compared the efficacy and safety of CPSNB with the single-injection popliteal sciatic nerve block group were included. The primary outcome parameters were visual analog scale (VAS) scores at postoperative 24, 48 and 72 h. The secondary outcome parameters were amount of oral analgesics consumed, overall patient satisfaction and need of admission after surgery. A sensitivity analysis was performed to explore the consistency of the results.ResultsIn comparison with the single-injection group, CPSNB was associated with a lower VAS score at postoperative 24 and 48 h (p < 0.05). There were no neuropathic symptoms or infection events after the nerve block. However, there were several minor complications associated with the pump and catheter system, with drug leakage being the most common complication (N = 26 of 187, 13.9%).ConclusionCPSNB is an effective method in pain management for outpatient foot and ankle surgery. Both methods appear to be safe as none of the patients experienced neuropathic symptoms or infection. Further studies with larger sample size are needed to compare the risk of major complications between the two methods.Level of evidenceI; meta-analysis.

Highlights

Foot and ankle surgery is increasingly performed in a same-day, outpatient setting but is associated with moderate to severe postoperative pain which may lead to prolonged post-anesthesia care unit (PACU) stay, unanticipated admission and decreased patient satisfaction [1,2,3]
5 articles that compared the efficacy of continuous popliteal sciatic nerve block (CPSNB) in outpatient foot and ankle surgery with singleinjection popliteal sciatic nerve block were included for our meta-analysis
The analysis showed consistent results of outcome parameters in the CPSNB group in comparison with the singleinjection group including visual analog scale (VAS) score at 24 h (SMD: -1.121; 95% CI − 1.969 to − 0.274), VAS score at 48 h (SMD: -1.022; 95% CI − 1.877 to − 0.167), VAS score at 72 h (SMD: -0.327; 95% CI − 0.823 to 0.168), total amount of oral analgesics consumed at 72 h (SMD: -0.554; 95% CI − 1.092 to − 0.276) and postoperative admission (OR: -0.172; 95% CI − 0.540 to 0.196)

Summary

Introduction

Foot and ankle surgery is increasingly performed in a same-day, outpatient setting but is associated with moderate to severe postoperative pain which may lead to prolonged post-anesthesia care unit (PACU) stay, unanticipated admission and decreased patient satisfaction [1,2,3]. Postoperative pain was one of the most common reasons for unanticipated admission, in which 57.6% of them were orthopaedic patients [4] This moderate to severe postoperative pain following foot and ankle surgery can persist up to postoperative day 3 [5], which single-injection popliteal sciatic nerve block may not be adequate to manage the pain [6]. The first aim of this meta-analysis was to determine the efficacy of CPSNB compared with single-injection group, as a postoperative pain management in patients who had undergone foot and ankle surgery. Continuous popliteal sciatic nerve block (CPSNB) has been performed in outpatient foot and ankle surgery as a regional anesthesia method to relieve postoperative pain. There are two purposes of this study: (1) to validate the efficacy of CPSNB with regards to better pain relief and reduced analgesics consumption; (2) to assess the safety of CPSNB

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Discussion

Conclusion