SLR - December 2014 - Jennifer A. Lipman

The Effect of Continuous Popliteal Sciatic Nerve Block on Unplanned Postoperative Visits and Readmissions after Foot Surgery - A Randomised, Controlled Study Comparing Day-Care and Inpatient Management

Reference: Saporito A, Sturini E, Borgeat A, Aguirre J. The Effect of Continuous Popliteal Sciatic Nerve Block on Unplanned Postoperative Visits and Readmissions After Foot Surgery - A Randomised, Controlled Study Comparing Day-care and Inpatient Management. Anaesthesia. 2014 Nov; 69(11): 1197-205.

Scientific Literature Review

Reviewed By: Jennifer A. Lipman, DPM
Residency Program: Cambridge Health Alliance

Podiatric Relevance: Postoperative pain after elective foot surgery is unpredictable and difficult to manage. Traditionally, patients are sent home from surgery with oral narcotics or are admitted for intravenous narcotics and observation. Oral narcotic medications are often not enough to reduce the patient’s pain to an acceptable level leading to emergency visits and possible readmission. Additionally, sending a patient home with oral narcotics to administer themselves can be dangerous if not used properly. A safe method, which is acceptable to the patient while being a cost effective alternative to admission, would greatly benefit the podiatric community. This study hypothesized that day surgery management using continuous perineural block following elective foot surgery does not lead to higher rates of outpatient visits or readmission than planned three day inpatient stay.

Methods: One Hundred Twenty patients with similar gender and ASA status undergoing unilateral toe osteotomies or hallux valgus repair were included in this prospective randomized study. The patients were assigned to two groups: day surgery or inpatient stay of 3 days. Both groups had an elastomeric analgesia pump with perineural popliteal nerve catheter placed and received 5 mL boluses with 0.5 percent Bupivicaine every hour for three days as needed. Both groups had the pump catheters removed after three days. Additional pain relief consisted of Diclofenac 50mg twice daily and Tylenol 1 g every six hours for the first three days. Oxycodone 5-10mg was given as needed for pain score above three. The treatment efficacy, complications, side effects and incidental problems with the catheters was checked by telephone questionnaire.

Results: Both groups had similar need for outpatient visits and readmissions. There was no difference between the two groups related to pain during the time the catheter was present or after the catheter was removed. Both groups reported similar rates of satisfaction. Two patients in the day surgery group were admitted for catheter-related problems and four patients in the inpatient group were readmitted for persistent pain at home despite oral pain medication. The net difference in cost of day surgery versus inpatient postoperative stay was $10,986.

Conclusions: The authors of this study concluded that continuous perineural block after elective foot surgery does not lead to an increase in outpatient visits or readmission. From this article, I can conclude that a perineural popliteal block is a safe and cost effective alternative to inpatient admission for pain control. For a patient with history of difficult to control postoperative pain or for someone with an allergy or contraindication to narcotic pain medication, I will consider continuous block as either an adjunct or alternative to traditional pain control methods before considering inpatient postoperative admission.

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