Regional anesthesia for foot and ankle surgery outcomes & patient satisfaction

M. El Sayad, M. Blundell, D. Townshend, J. Coorsh, A.N. Murty, R.K. Kakwani

Introduction: There is an increasing popularity of regional anesthesia (blocks) in foot and ankle surgery. Its hindered by the requirement of trained anesthetists, equipment, costs, and complications. Its advantages are avoiding a general anaesthetic and its associated risks, reduced pain scores, opiate requirement and hospital stay. Our aim is to assess patient satisfaction with this service.

Method: Using prospective data collection between 2013 to 2015, a total of 357 patients identified having foot and ankle procedures with a regional anesthetic. Complete pre, intra and postoperative information obtained in 255 cases from patient's notes, telephone questionnaire and out patients clinics.

Results: From 255 patients, 168 females and 87 males with an age range between 15 to 91 years. 199 patients were day cases and 56 were inpatients for either surgical or social reasons. 189 forefoot and 66 hindfoot procedures. 38 patients had a general anesthetic and 217 were either sedated or awake. 64 ankle and 91 popliteal blocks, the average time to perform the block was 13 minutes. Intraoperative analgesia was considered perfect in 232 cases and inadequate in 23 cases, of which 5 were converted to a general anesthetic. In recovery 191 (75%) had a pain score of zero. The block duration lasted between 4 to 48 hours. 66 patients had opiate analgesia postoperatively. 234 patients declared having adequate analgesia in their postoperative period. 247 patients (97%) said they would have the block again for surgery and 239 said they would recommend it. There were no long-term postoperative neurological complications from these blocks.

Conclusion: Our study, one of the largest in the literature shows that regional anesthesia was responsible for a reduction in inpatient stay, pain scores, analgesia requirements and has a high patient satisfaction. With appropriate trained personnel and equipment a very safe procedure with no long term complications.