Summary
We used 20 ml ropivacaine 0.75% for ankle blocks before foot surgery in 90 participants who we allocated in equal numbers to: perineural dexamethasone 8 mg and intravenous saline 0.9%; ...perineural saline 0.9% and intravenous dexamethasone 8 mg; or perineural and intravenous saline 0.9%. Dexamethasone increased the median (IQR range) time for the return of some sensation or movement, from 14.6 (10.8–18.8 5.5–38.0) h with saline to 24.1 (19.3–29.3 5.0–44.0) h when given perineurally, p = 0.00098, and to 20.9 (18.3–27.8 8.8–31.3) h when given intravenously, p = 0.0067. Dexamethasone increased the median (IQR range) time for the return of normal neurology, from 17.6 (14.0–21.0 9.5–40.5) h with saline to 27.5 (22.0–36.3 7.0–53.0) h when given perineurally, p = 0.00016, and to 24.0 (20.5–32.3 13.0–42.5) h when given intravenously, p = 0.0022. Dexamethasone did not affect the rates of block success, postoperative pain scores, analgesic use, or nausea and vomiting. The route of dexamethasone administration did not alter its effects.
The learning curve to reach technical proficiency for third-generation percutaneous or minimally invasive chevron and Akin osteotomies (PECA/MICA) is recognized to be steep however it is poorly ...defined in the literature. This study is a retrospective review of the first 58 consecutive PECA cases of a single surgeon. The primary outcome was the number of cases required to reach technical proficiency as defined by the operation time. Secondary outcomes included radiation exposure, radiographic deformity correction, and complication rates. Between November 2017 and March 2019, 61 consecutive PECA cases were performed with outcome data available for 58 of these (95%). Technical proficiency was reached after 38 cases. Operation time and radiation exposure significantly decreased after this transition point (p < .05). There was no difference in complication rate or radiographic deformity correction regardless of position along the learning curve (p > .05). In conclusion, the mean number of cases required to reach technical proficiency in third-generation PECA is 38 cases. The complication rate does not correlate to the number of cases performed, therefore surgeons interested in learning minimally invasive surgery can be reassured that there is unlikely to be an additional risk of harm to a patient during the learning curve.
Background: Either a nylon single suture or adhesive tape in the form of Steri strip are commonly used for the closure of portals in ankle arthroscopy. The purpose of this study was to compare the ...two methods with regards to their safety, complications and cosmetic result. Methods: This was a prospective cross over study of 100 patients who underwent ankle arthroscopy. Materials used for wound closure were either a 3–0 nylon suture or a single Steri strip. Portals were reviewed according to a validated wound scoring system. Parameters such as the age and gender of the patients, the duration of tourniquet use and the use of an intraarticular corticosteroid injection at wound closure were also studied. Results: Ninety-five patients were included in the statistical analysis. No technique was found to be superior in terms of the wound description (p = 0.164), infection grade (p = 0.232), infection treatment (p = 0.557) and the cosmetic appearance (p = 0.371). Seventy-two percent of patients had a good to excellent cosmetic result. There were two cases of infection requiring administration of antibiotics, one from each method of closure. Of the independent parameters, the use of cortisone was related to a lower infection treatment score (p = 0.013). Patients with signs of infection had a shorter total tourniquet time compared to the patients with no infection (p = 0.002). Conclusion: The use of either a single suture or Steri strip in the closure of ankle arthoscopy portals has equivalent results. Both methods were safe with equivalent cosmesis and low infection rates.
Level of Evidence: II; Prospective Comparative Study
One hundred consecutive patients made an informed preoperative choice for elective forefoot surgery between general anaesthetic (GA) and ankle block (AB). Fourteen patients requested GA, 57 AB and 29 ...were ambivalent, but chose to proceed with AB and sedation anaesthesia after further explanation. The ambivalent group had a higher level of preoperative concerns (P < 0.03) and required more intraoperative sedation, but were equally satisfied at review. AB patients had longer postoperative pain relief and fewer required strong analgesia on both the day of operation and the next day (P < 0.05). One AB patient required unplanned conversion to GA for tourniquet pain. With adequate preoperative counselling and additional sedation anaesthesia, if required, there is a high voluntary acceptance of ankle block and good subjective outcome for forefoot surgery.
Bilateral ankle blocks: A prospective audit Rudkin, Glenda E; Rudkin, Adam K; Dracopoulos, George C
ANZ journal of surgery,
01/2005, Letnik:
75, Številka:
1-2
Journal Article
Recenzirano
Background: There are significant advantages to the practice of bilateral ankle block. However, clinicians are reluctant to employ this technique due to concerns over reliability, local anaesthetic ...longevity and toxicity, surgical efficiency, and patient comfort.
Methods: Sixty‐six patients undergoing bilateral ankle blocks during mid‐ and forefoot surgery were audited to determine success rate, local anaesthetic safety and efficacy, and patient acceptance. Intravenous sedation was administered both during insertion of ankle blocks and intraoperatively, as requested by the patient and as deemed necessary by the anaesthetist. The choice of local anaesthesia was either a 50/50 mixture of lignocaine 1.5% plain and ropivacaine 7.5 mg/mL, ropivacaine 7.5 mg/mL alone or ropivacaine 7.5 mg/mL and clonidine 1 µg/kg.
Results: A total of 89% of patients had a successful bilateral ankle block. Ropivacaine and clonidine combination, ropivacaine, and ropivacaine and lignocaine combination provided a mean length of action of 17 h, 14 h and 8 h, respectively. No adverse local anaesthetic events were reported. Sixty‐one per cent of patients remembered intraoperative events; only one patient would choose not to have the procedure performed again under ankle blocks.
Conclusions: The present audit demonstrates that bilateral ankle blocks are a safe and efficient technique. With appropriate doses of sedative drugs both during insertion of the ankle block and surgery, patients remain comfortable.
Background:
While use of a thigh tourniquet with general anesthesia is widely accepted, use of an ankle tourniquet in the awake patient is more controversial. In particular, it is not clear how long ...patients tolerate this device or what the consequences are of intraoperative tourniquet pain.
Method:
A prospective audit was done of 1000 patients undergoing midfoot and forefoot surgery using an ankle block. We examined the intraoperative problems associated with the use of an ankle tourniquet, particularly the role and consequences of intraoperative tourniquet pain. Risk factors for tourniquet pain were statistically examined, and patient acceptance was gauged through followup questions.
Results:
With correct application and the option of sedation, 3.1% of patients complained of tourniquet pain. In 0.4% of patients tourniquet pain necessitated a conversion to general anesthesia. A significant association was found between tourniquet pain and both age and tourniquet time. We found that for patients younger than 70 years of age, the tourniquet can be applied comfortably for up to 30 minutes in over 97%. For each 11 minutes beyond this, another 1% of patients reported tourniquet pain. However, patients 70 years or older had an average 3.5 times increase in tourniquet pain. In this age group the tourniquet can be applied comfortably for up to 30 min in 91%. For each 3.2 minutes beyond this, another 1% reported tourniquet pain. When questioned, 97.2% of our patients reported that they would have surgery again with an ankle tourniquet.
Conclusions:
Our audit shows that with correct application and the option of sedation the ankle tourniquet is well tolerated by most patients. However, clinicians need to be mindful that patients 70 years of age or older are at greater risk of tourniquet pain and that in all patients the risk of tourniquet pain gradually increases when application times exceed 30 min.
Cervical epidural haematoma following minor trauma is unusual in normal adults. It is important that the condition is diagnosed and treated promptly in order to improve the prognosis. Surgery to ...evacuate the haematoma is the treatment of choice.
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