ULTRASOUND-GUIDED ANKLE BLOCK VS SCIATIC-SAPHENOUS NERVE BLOCK FOR SCARF OSTEOTOMY: A CASE REPORT
ESRA Academy. Goh H. Sep 8, 2016; 138363; 0201 Topic: Peripheral Nerve Blocks
Dr. Hui Fen Jacqueline Goh
Dr. Hui Fen Jacqueline Goh

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Abstract
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Background and Aims:

Scarf osteotomy for hallux valgus correction is associated with significant postoperative pain. Several peripheral nerve block (PNB) analgesic techniques have been described but it remains unclear which is superior.

Methods:

A 44-year-old lady presented for elective bilateral scarf osteotomy. Informed consent was obtained for general anaesthesia with preoperative ankle block on one side, and popliteal-sciatic and saphenous block on the other, to compare the two PNB techniques. Right ankle block was performed using 25G hypodermic needle with 8ml 0.5% ropivacaine to posterior tibial nerve, 5ml to superficial peroneal nerve and 7ml to saphenous nerve. Left sciatic block was performed using 22G Stimuplex® needle with 15ml 0.5% ropivacaine, and saphenous block with 5ml 0.5% ropivacaine. All injections were performed under ultrasound guidance with good perineural spread visualised. Pre-surgery assessment revealed sensory blockade in expected distributions. General anaesthesia was administered with propofol-fentanyl induction, ProsealTM laryngeal mask and sevoflurane maintenance. Surgery proceeded uneventfully.

Results:

Postoperatively, patient reported mild pain in the right first web space (deep peroneal nerve distribution, not blocked). Ankle block fully resolved 8 hours post-block, while popliteal-saphenous block resolved 17 hours post-block. Patient was pain-free on the first postoperative day with oral analgesia. She reported satisfaction with both techniques, but favoured the sciatic-saphenous block because it involved fewer injections, injections were less painful, and analgesic effect lasted longer. There were no complications.

Conclusions:

This case study of two PNB techniques for scarf osteotomy in a single patient showed that the sciatic-saphenous block provided greater patient comfort, longer postoperative analgesia and improved patient satisfaction. 

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