SLR - February 2020 - Tyler Slattery
Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery
Reference: Graney C, Shibuya N, Patel H, Jupiter DC. Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery. Foot Ankle Spec. 2019;12(6):530–534.
Scientific Literature Review
Reviewed By: Tyler Slattery, DPM
Residency Program: Scripps Mercy Kaiser Hospital – San Diego, CA
Podiatric Relevance: The use of popliteal blocks for postoperative pain management has grown in popularity in surgeries performed in the lower extremity. With more tight regulations on opioid usage and prescriptions, postoperative pain management modalities are ever more important. Popliteal blocks have been reported to be effective for postoperative pain management with low complication rates. However, complications can lead to neuropathic symptoms, paresthesias and motor weakness. Local field blocks have also been documented with adequate analgesia rates and very low minor complication rate. The purpose of this study is to determine if popliteal blocks are more effective in preventing ED visits compared with local field blocks alone, after foot and ankle surgeries.
Methods: This is an IRB approved study including a total of 101 patients who underwent foot and ankle surgery between January 2015 and December 2016. Inclusion criteria included patients who had foot or ankle surgery during the stated time frame with ages between 18 and 80 years of age. Patients who underwent forefoot surgery were excluded as this institution had a tendency to perform popliteal blocks for midfoot and rearfoot cases. Patients were identified if they presented to the ED within 30 days of surgery and were identified based on surgery related pain problems. Type of anesthesia was reviewed and if the patient had both a local and popliteal block, they were categorized into the popliteal group.
Results: Total of 101 patients were included in this study during the time frame of January 2015 and December 2016. Of those, 26 reported to the ED for pain within 30 days of surgery. 73 (72.3 percent) patients had a local block only and 28 (27.7 percent) patients were categorized into the popliteal block group. There was no difference in type of block and ED visit for pain detected. There was a significant association between longer cases ( >91 minutes) and use of a popliteal block.
Conclusions: The current study did not demonstrate that popliteal blocks were beneficial as compared with local blocks in preventing ED visits due to post-operative pain. Popliteal blocks do have associated neurologic complications in the form of sensory, motor, or both. This study does show that local blocks prevent ED visits due to postoperative pain with a similar rate to popliteal blocks. Local blocks are an effective modality for postoperative analgesia with a decreased risk of lower extremity complications compared to popliteal blocks.