The efficacy of combined popliteal and ankle blocks in forefoot surgery

Abstract

Background: Postoperative pain following forefoot surgery can be difficult to control with oral analgesia so regional analgesic methods have become more prominent in foot and ankle surgery. The effects of ankle and popliteal blocks performed separately have been well described in the literature but we have not found any study that looks at the combined effects of the two procedures. It is the aim of this study to evaluate the efficacy of a combination of these blocks and decide if they provide significantly better postoperative analgesia than ankle block alone in forefoot surgery. Methods: This is an ongoing prospective, randomised, controlled and single blind study. Proposed end-point should be reached in 3 months. The total number of patients to be included will be 60, with 30 in ankle block only group (control) and 30 in ankle and popliteal blocks group. All patients are to undergo forefoot surgery. Postoperative pain is evaluated in the form of a visual analogue scale and verbal response form. Evaluations take place four times for each patient: in the recovery room, 6 hours postoperatively, 24 hours postoperatively and on discharge. The pain assessor, who helps the patient complete the pain evaluation forms, is blinded to the number of blocks used. The amount of opiate analgesia required whilst as an inpatient will also be recorded. On discharge the patient is asked to rate their satisfaction with the pain experienced during their hospital stay. Results will be analysed using paired Students t test. Results: Early results are showing that combined ankle and popliteal blocks provide better analgesic effect than ankle block alone. This is shown both in the patient response forms and also in reduced amounts of opiate analgesia required. Further discussion of the results and conclusions will be drawn once the study has been completed.