Ultrasound-guided Ankle Block Research Articles

Comparison of Ultrasound-Guided Ankle Block Versus Anatomical Landmark-Guided Ankle Block in Ankle and Foot Surgery Under Regional Anesthesia

Background: As more patients undergo foot and ankle surgery, regional anesthesia's significance in postoperative treatment has grown. Anesthesiologists and pain specialists have adopted regional anesthesia in large numbers. Numerous techniques, such as nerve stimulation, anatomical markers, and ultrasonography, have been used to block the saphenous nerve. Objective: The present study aimed to assess the traditional anatomic landmark-guided approaches in lower limb surgery performed under regional anesthesia with ultrasound-guided ankle blocks in surgical anesthetic methods. Method: This randomized control study is carried out at the hospital. A total of 60 participants with scheduled foot and ankle surgery were randomly divided into two study groups (each n=30), Ultrasound-guided ankle block (USG) and anatomical landmark-guided ankle block (ALG). Results: Recruited participants had a mean age of 50.2± 14.02, with 39 (65%) male and 21( 35%) female. A total of 49 patients (82%) were able to undergo anesthesia successfully, with 26 (86.60%) of those patients belonging to the USG block group and 23 (76.60%) of those patients belonging to the ALG block group undergoing anesthesia successfully (p-value = >0.999). Practical implication: This study will help to comprehend either ultrasound-guided ankle block or anatomical landmark-guided ankle block in foot surgeries give better results. Conclusion: The results of this research indicate that the success rates of the two procedures are statistically insignificantly different; however, the USG ankle block for surgical anesthesia performed under regional anesthetic had a greater success rate than the anatomic landmark-guided technique. Keywords: Foot surgery, USG ankle block, anesthesia, ALG Block, postoperative treatment

Comparison of Ultrasound Guided Ankle Block versus Anatomical Landmark Guided Ankle Block in Minor Ankle and Foot Surgeries

Background: Regional anesthesia has increasingly expanded its role in perioperative care of patients undergoing foot and ankle surgery. The use of regional anesthesia has been widely implemented among anesthesiologists and pain providers. Multiple approaches for sephanous nerve blockade have been used including nerve stimulation, anatomical landmarks and ultrasound. It has been observed in previous studies that USG ankle block is more successful as compared to conventional anatomical landmark guided nerve block; so this study was planned to get precise and reliable results regarding both techniques in our local population. Objective: To compare the methods of surgical anesthesia of Ultrasound-guided ankle block versus conventional anatomic landmark-guided techniques in lower limb surgery under regional anesthesia. Materials and methods: This randomized control was carried out at Department of Anesthesia Mayo Hospital Lahore. After meeting the inclusion and exclusion criteria 50 patients (25 in each group ) were enrolled. Patients were randomly divided into two groups using lottery method. Group A patients underwent USG ankle block while group B patients underwent conventional anatomic landmark guided ankle block. Results: Mean age of patients was 46.96±11.578 years; 40(80%) patients were male and 10(20%) patients were females. Successful anesthesia was achieved in 42 (84%) patients; in which in USG block group the successful anesthesia was achieved in 22(88%) patients and in ALG block group successful anesthesia was achieved in 20(80%) patients (p value =0.702) Conclusion : Findings of this study conclude that both techniques have statistically insignificant difference in terms of success rate , however USG ankle block for surgical anesthesia showed higher success rate as compared to anatomic landmark guided technique in lower limb surgery under regional anesthesia. Keywords: Ultrasound-guided Ankle Block, Anatomic Landmark-guided Ankle Block, Lower limb surgery.

How I do it: ultrasound-guided ankle block

How I do it: ultrasound-guided ankle block

P.336 Depression, diabetes and expression of cellular adhesion molecules

Regional anaesthesia is commonly utilised for foot and ankle surgery. Debate remains at to the level of regional anaesthesia that is required. The objective of this study was to evaluate whether surgeon-delivered “blind” local anaesthetic infiltration around the first ray (metatarsal block without ultrasound guidance) was as effective as an ultrasound guided ankle block in providing post-operative analgesia after osseous first ray surgery performed under general anaesthetic.50 patients were recruited to a single surgeon and anaesthetist double-blinded randomised controlled trial at a single-centre. 20 mls of 0.5% levobupivacaine was used to perform either an ankle or metatarsal nerve block.Forty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The demographics were comparable between groups. There was no statistical difference in visual analogue pain scores at two (21.3 vs 15.2), six (23.6 vs 20.8) and 24 (42.2 vs 50.4) hours following the procedure between the two groups (metatarsal block vs ankle block). Metatarsal block groups had a faster return of normal sensation (2.3 vs 2.8 h) but there was no difference in time to safe mobilisation (2.6 vs 2.8 h).This study demonstrates the efficacy and safety of surgeon delivered “blind” metatarsal block is comparable to an ultrasound guided ankle block for first ray surgery performed under general anaesthetic.1.

Ultrasound-guided ankle block. History revisited.

Following forefoot surgery, compared to the traditional multimodal approach, regional anesthesia and analgesia provides high quality pain relief, decreases opioids consumption and leads to very high satisfaction scores. Traditional regional techniques relied either on wound infiltration, landmark technique ankle blocks or popliteal sciatic nerve block. Numerous anatomic variations of the different nerves might lead to failure following a blind technique. The current evolution towards ambulatory care will push surgical teams to favor techniques that simplify postoperative treatment and encourages immediate ambulation. The development of Ultrasound Guided Blocks has enabled us to perform very selective and precise nerve blocks. Ankle blocks provide excellent intraoperative anesthesia as well as long postoperative pain relief. Complications are rare using regional anesthesia for postoperative analgesia even after extensive foot surgery. Revival of ankle blocks is a perfect example of the high impact of new technological advances in improving ambulatory surgical care after foot surgery.

Is regional ankle block needed in conjunction with general anaesthesia for first ray surgery? A randomised controlled trial of ultrasound guided ankle block versus “blind” local infiltration

BackgroundRegional anaesthesia is commonly utilised for foot and ankle surgery. Debate remains at to the level of regional anaesthesia that is required. The objective of this study was to evaluate whether surgeon-delivered “blind” local anaesthetic infiltration around the first ray (metatarsal block without ultrasound guidance) was as effective as an ultrasound guided ankle block in providing post-operative analgesia after osseous first ray surgery performed under general anaesthetic. Methods50 patients were recruited to a single surgeon and anaesthetist double-blinded randomised controlled trial at a single-centre. 20mls of 0.5% levobupivacaine was used to perform either an ankle or metatarsal nerve block. ResultsForty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The demographics were comparable between groups. There was no statistical difference in visual analogue pain scores at two (21.3 vs 15.2), six (23.6 vs 20.8) and 24 (42.2 vs 50.4) hours following the procedure between the two groups (metatarsal block vs ankle block). Metatarsal block groups had a faster return of normal sensation (2.3 vs 2.8h) but there was no difference in time to safe mobilisation (2.6 vs 2.8h). ConclusionThis study demonstrates the efficacy and safety of surgeon delivered “blind” metatarsal block is comparable to an ultrasound guided ankle block for first ray surgery performed under general anaesthetic. Level of evidence1.

Randomised Controlled Trial of Ankle Block Versus Metatarsal Block for First Ray Surgery

Category: Bunion Introduction/Purpose: First ray arthrodesis or osteotomy is a day surgery procedure performed commonly under general anaesthetic. One of the aims with such procedures is to ensure our patients are discharged on the day of surgery and are relatively pain free on discharge. This is often achieved by the use of local anaesthetic blockades, either as an ankle block or as a metatarsal block. There are studies published on the effectiveness of ankle block for first ray surgery but there is a dearth of studies on metatarsal block. Therefore the aim of this study is to compare the effectiveness of ankle block versus metatarsal block in conjunction to general anaesthetic for first ray surgery. Methods: Both local trust board approval and National Research Ethics Committee approval were granted for the study. Statistical analysis to ensure an adequately powered study was performed. Fifty patients undergoing arthrodesis or osteotomy of the first ray were recruited into this study and randomly allocated to the cohort to receive either a metatarsal block or an ankle block. All patients had general anaesthesia. Those patients randomized to ankle block had this performed after induction of general anaesthesia using ultrasonography. Those patients randomized to metatarsal block had this performed at the end of the operative procedure. Patients scored their pain level using a visual analogue scale (0-10) at 2, 6 and 24 hours. A physiotherapist, who was blinded to their treatment arm, assessed patients at hourly intervals from two hours. Patients were contacted by telephone by a research nurse, who was also blinded to their treatment arm, over 24 hours from discharge. Results: Forty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The majority of the patients were female (44 patients) with an average age of 53 years (range 31-76 years). Analysis of pain scores showed that there was no statistically significant difference between the two groups at any of the measured time periods. Analysis of their analgesic requirement in the first 24 hours after surgery again revealed no striking difference between the two cohorts. Similarly analysis of the time taken to safely mobilise revealed that there was no difference between the two groups. However analysis of the time taken to perform the anaesthesia highlighted a mean addition of eleven minutes when an ultrasound guided ankle block was performed. Conclusion: This prospective randomised blinded study demonstrates that metatarsal blocks are just as effective in giving post- operative analgesia as ultrasound guided ankle blocks in patients undergoing first ray surgery under general anaesthetic.

Ultrasound-guided ankle block: An attractive anaesthetic technique for foot surgery

Foot innervation, defined as distal to the tibial and fibular malleoli, is provided by five nerves, namely the tibial, peroneal (deep and superficial), sural and saphenous nerves. Blockade of these nerves is referred to as ankle block. The main advantage of using this block in foot surgery over other regional techniques is the absence of motor blockade above the ankle, which allows faster mobility after surgery. The use of ultrasound for this block has been shown to be of higher clinical efficacy when compared to a landmark approach. The purpose of this continuing education article is not only to detail the anatomy and sonoanatomy of the five nerves innervating the foot, but the ultrasound technique as well. The ultrasound-guided ankle block can be used alone as anaesthetic technique or as adjuvant for analgesia in foot surgery.

Bloqueo de tobillo guiado por ultrasonido: una técnica anestésica atractiva para cirugía de pie

Foot innervation, defined as distal to the tibial and fibular malleoli, is provided by five nerves, namely the tibial, peroneal (deep and superficial), sural and saphenous nerves. Blockade of these nerves is referred to as ankle block. The main advantage of using this block in foot surgery over other regional techniques is the absence of motor blockade above the ankle, which allows faster mobility after surgery. The use of ultrasound for this block has been shown to be of higher clinical efficacy when compared to a landmark approach. The purpose of this continuing education article is not only to detail the anatomy and sonoanatomy of the five nerves innervating the foot, but the ultrasound technique as well. The ultrasound-guided ankle block can be used alone as anaesthetic technique or as adjuvant for analgesia in foot surgery.

Ultrasound-guided ankle block

Ultrasound-guided ankle block

Ultrasound-Guided Ankle Block for Forefoot Surgery

Ultrasound-Guided Ankle Block for Forefoot Surgery

Ultrasound-Guided Ankle Block for Forefoot Surgery

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. One hundred patients scheduled for bunion surgery under ankle block were prospectively studied. We performed ultrasound-guided individual blocks of the tibial, deep peroneal, superficial peroneal, and sural nerves. After obtaining complete sensory block of these nerves, we mapped the SaN sensory territory as such area without anesthesia on the medial side of the foot. Every nerve block was successful within 10 minutes of injection. The saphenous territory extended into the foot to 57 ± 13 mm distal to the medial malleolus. This distal margin was 22 ± 11 mm proximal to the first tarsometatarsal joint. The proximal end of the surgical incision was located 1 cm distal to the first tarsometatarsal joint. In only 3 patients (3%), the area of SaN innervation reached the proximal end of the planned incision. Ultrasound-guided ankle block is a highly effective technique for bunion surgery. The sensory territory of the SaN in the foot seems to extend only to the midfoot. According to our sample, 97% of the patients undergoing bunion surgery under an ankle block would not benefit from having a SaN block.

Ultrasound-Guided Versus Anatomic Landmark-Guided Ankle Blocks

Ultrasound-guided (USG) ankle block has been described; however, its clinical efficacy compared with conventional anatomic landmark-guided (ALG) techniques remains undetermined. We performed a 6-year retrospective cohort study of all ankle blocks performed for foot surgery and extracted demographic, intraoperative, and postoperative outcome data. We divided blocks into 2 groups for comparison, depending on whether they were performed using an ALG technique or a USG technique. We identified 655 patients who received unilateral ankle block and 58 patients who received bilateral ankle block; we analyzed these separately. Trainees performed most blocks (approximately 80%). In patients receiving unilateral ankle block, successful surgical anesthesia was more likely in the USG group (84% versus 66%, P < 0.001). Patients in the ALG group were more likely to require supplemental local anesthesia (10% versus 5%, P = 0.04), unplanned general anesthesia (17% versus 7%, P = 0.001), or supplemental fentanyl (18% versus 9%, P = 0.002). Postanesthetic care unit pain scores were similar between groups. However, patients in the ALG group were more likely to receive intravenous opioids (21% versus 12%, P = 0.01), and they received a higher mean opioid dose (10.6 versus 8.7 mg intravenous morphine, ALG versus USG, P = 0.022). In patients receiving bilateral ankle block, successful surgical anesthesia was also more likely in the USG group (84% versus 57%); however, this was not statistically significant because of the small sample size. This study demonstrates that the USG technique of ankle block improves clinical efficacy compared with a conventional ALG technique, particularly in the hands of less-experienced practitioners.

Low-Volume Ultrasound-Guided Nerve Block Provides Inferior Postoperative Analgesia Compared to a Higher-Volume Landmark Technique

Ultrasound guidance reduces the required local anesthetic volume for successful peripheral nerve blockade, but it is unclear whether this impacts postoperative analgesia. This prospective, randomized, observer-blinded study tested the hypothesis that a low-volume ultrasound-guided ankle block would provide similar analgesia after foot surgery compared with a conventional-volume surface landmark technique. A total of 72 patients presenting for elective foot surgery under general anesthesia were randomized to receive a low-volume ultrasound-guided ankle block (n = 37; ropivacaine 0.5% adjacent the anterior/posterior tibial arteries and short saphenous vein; subcutaneous infiltration around the saphenous and superficial peroneal nerves) or conventional-volume surface landmark guided technique (n = 35; 30 mL of ropivacaine 0.5%). Patients received regular postoperative acetaminophen, diclofenac, and rescue tramadol. Assessment was in the recovery room and at 24 hours for pain and tramadol consumption. Mean (SD) total local anesthetic volume for the low-volume ultrasound group was 16 (2.1) mL. Block success in the recovery room was similar between groups (low-volume ultrasound 89% versus conventional-volume landmark 80%, P = 0.34; however, during the first 24 hours, numerically rated (0-10) "average pain" (median [10-90th percentiles] = 1 [0-4] versus 0 [0-2], P = 0.01), worst pain at rest (1 [0-6] versus 0 [0-2], P = 0.03), and the proportion of patients requiring rescue tramadol (% [95% confidence interval]: 50 [34-46] versus 20 [10-36], P = 0.01) were higher in the low-volume ultrasound group. Numerically rated numbness, weakness, satisfaction, and procedural time were similar between groups. Low-volume ultrasound-guided ankle block is associated with a high block success rate after foot surgery; however, compared with a conventional volume (surface landmark) technique, the reduced local anesthetic volume marginally compromises postoperative analgesia during the first 24 hours.

Ultrasound-Guided Ankle Block in Stone Man Disease, Fibrodysplasia Ossificans Progressiva

In this case report, we describe the successful use of ultrasound-guided regional anesthesia in progressive fibrodysplasia ossificans (stone man disease), a condition commonly regarded as a contraindication for regional anesthesia. A patient with advanced fibrodysplasia ossificans progressiva presented with osteomyelitis of a foot and was scheduled for resection of the infected bones and soft tissue. Ultrasound imaging allowed us to identify the obscured anatomic landmarks for ankle block anesthesia and to restrict the injection of local anesthetics to the epifascial tissue and subcutaneous compartment. With this ankle block, the patient uneventfully underwent surgery without need for additional sedative or analgesic drugs.