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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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.


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.


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.


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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