THE ROLE OF ULTRASOUND-GUIDED POPLITEAL NERVE BLOCK IN OPIOID-FREE ANESTHESIA FOR AN OSTEOSYNTHESIS MATERIAL EXTRACTION AFTER BILATERAL CALCANEAL FRACTURE
Keywords:
Popliteal Nerve block, Opioid free anesthesia, Ultrasound guided nerve blockAbstract
Peripheral nerve blocks (PNBs) for intraoperative and perioperative pain management are often part of the anesthetic plan for foot and ankle surgery. Usage of peripheral nerve blocks may limit occurrence of general anesthesia related complications by decreasing the amount of intraoperative anesthetic medications usage. Decreased postoperative opioids use and earlier time to discharge were encountered when peripheral nerve blocks were used. This case presentation is about a 38-year-old male patient with bilateral calcaneal OSM extraction and left calcaneal osteotomy, who refused spinal anesthesia, as well as refused to be awake during the procedure. Avoiding opioids was possible with usage of bilateral ultrasound-guided popliteal nerve block with 10 ml of 2% Lidocaine on each side. The purpose of this case report is to present the role of PNBs in intraoperative and postoperative decrease of opioids usage, as well as the absolute hemodynamic stability met during the procedure and pain-free extubated and awakened patient.
References
Kirksey MA, Haskins SC, Cheng J, Liu SS. Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 2015; 10(9): e0137312. doi: 10.1371/journal.pone.0137312.
Gabriel RA, Ilfeld BM. Peripheral nerve blocks for postoperative analgesia: From traditional unencapsulated local anesthetic to liposomes, cryoneurolysis and peripheral nerve stimulation. Best Pract Res Clin Anaesthesiol 2019; 33(3): 293-302. doi: 10.1016/j.bpa.2019.06.002.
Sara J. Judickas, DPM, Ryan Stone, DPM, AACFAS, Ian Barron, DPM, FACFAS, Popliteal Nerve Blocks: Risks and Benefits in Foot and Ankle Surgery, Podiatry Today, June 2023, Vol. 36, Issue 6
Sagherian BH, Kile TA, Seamans DP, Misra L, Claridge RJ. Lateral popliteal block in foot and ankle surgery: Comparing ultrasound guidance to nerve stimulation. A prospective randomized trial. Foot Ankle Surg 2021; 27(2): 175-180. doi: 10.1016/j.fas.2020.03.011.
Boysen PG 2nd, Pappas MM, Evans B. An Evidence-Based Opioid-Free Anesthetic Technique to Manage Perioperative and Periprocedural Pain. Ochsner J 2018; 18(2): 121-125. doi: 10.31486/toj.17.0072
Cardwell TW, Zabala V, Mineo J, Ochner CN. The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management. Am Surg 2022; 88(12): 2842-2850. doi: 10.1177/00031348211023395.
Blair TT, Weatherley TS, Panchbhavi VK. Techniques and complications of popliteal nerve blocks. Foot Ankle Surg 2022; 28(7): 852-857. doi: 10.1016/j.fas.2021.11.008.
Barreveld A, Witte J, Chahal H, Durieux ME, Strichartz G. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth Analg 2013; 116(5): 1141-1161. doi: 10.1213/ANE. 0b013e318277a270.
Araujo MC, Sinnott CJ, Strichartz GR. Multiple phases of relief from experimental mechanical allodynia by systemic lidocaine: responses to early and late infusions. Pain 2003; 103: 21-29. https://doi.org/10.1016/s0304-3959(02)00350-0.
Mendicino RW, Statler TK, Catanzariti AR. Popliteal sciatic nerve blocks after foot and ankle surgery: an adjunct to postoperative analgesia. J Foot Ankle Surg 2002; 41(5): 338-341. doi: 10.1016/s1067-2516(02)80055-2.
Kahn RL, Ellis SJ, Cheng J, Curren J, Fields KG, Roberts MM, YaDeau JT. The Incidence of Complications Is Low Following Foot and Ankle Surgery for Which Peripheral Nerve Blocks Are Used for Postoperative Pain Management. HSS J 2018; 14(2): 134-142. doi: 10.1007/s11420-017-9588-y.
Rodziewicz TL, Stevens JB, Ajib FA, Tunnell DJ. Sciatic Nerve Block. 2023 Jun 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.