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BENEFITS OF INTRODUCING POPLITEAL SCIATIC NERVE BLOCK CATHETERS FOR POST-OPERATIVE ANALGESIA FOLLOWING MAJOR FOOT ANKLE SURGERY IN COMPARISON TO SINGLE SHOT TECHNIQUES
ESRA Academy. Cruickshank R. Sep 8, 2016; 138401
Topic: Peripheral Nerve Blocks
Dr. Ross Cruickshank
Dr. Ross Cruickshank

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Abstract
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Background and Aims:

Audit comparing the analgesic efficacy of existing practice of single shot regional nerve blocks (popliteal + Adductor canal or saphenous nerve blocks) versus introduction of nerve block plus popliteal sciatic nerve catheter for elective major foot and ankle surgery. 

Methods:

Retrospective review of adults undergoing elective Total ankle replacement and mid/hindfoot fusions between March 2014–March 2015 and prospective outcomes with catheter technique from June 2015–January 2016.  Data collected included intra-operative opiate use, post-operative opiate consumption, time to mobilisation, length of stay and catheter related complications.

Results:

68 patients underwent combination ultrasound (US) guided popliteal nerve block plus US guided Adductor canal block or landmark saphenous nerve block.  32 patients received US guided Popliteal catheter insertion plus Adductor canal block.  Intraoperative opiate consumption was similar between the two groups (Mean 115mcg Fentanyl vs 172mcg and 1.4mg iv morphine vs 2.5mg).  Postoperative opiate consumption was significantly reduced in the catheter group (First 24hours 34mg morphine vs 7.4mg.  Total opiate consumption 63mg vs 38mg morphine).  Time to mobilisation was similar (28.7h vs 30h).  Most patients in each group were discharged 2days post-operatively (80% vs 78%).  5 patients (14%) had accidental catheter disconnection. 2 patients had malpositioned catheters resulting in ineffective analgesia.  No major complications recorded.

Conclusions:

The introduction of popliteal catheters significantly improved post-operative analgesia.  Catheters were not associated with significant delays in time to mobilisation or discharge.  There were a number of cases of dislodgement and malposition making it important that robust systems are in place for pain-team follow-up and the availability of rescue analgesia. 

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