Jarrell Kathleen, McDonald Elizabeth, Shakked Rachel, Nicholson Kristen, Kasper Vincent, Raikin Steven M
1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Foot Ankle Int. 2018 Mar;39(3):332-337. doi: 10.1177/1071100717744331. Epub 2017 Dec 18.
The increasing scope and complexity of foot and ankle procedures performed in an outpatient setting require more intensive perioperative analgesia. Regional anesthesia (popliteal and saphenous nerve blocks) has been proven to provide satisfactory pain management, decreased postoperative opioid use, and earlier patient discharge. This can be further augmented with the placement of a continuous-flow catheter, typically inserted into the popliteal nerve region. This study investigated the use of a combined popliteal and saphenous continuous-flow catheter nerve block compared to a single popliteal catheter and single-injection saphenous nerve block in postoperative pain management after ambulatory foot and ankle surgery.
A prospective study was conducted using 60 patients who underwent foot and ankle surgery performed in an outpatient setting. Demographic data, degree of medial operative involvement, American Society of Anesthesiologists physical classification system, anesthesia time, and postanesthesia care unit time were recorded. Outcome measures included pain satisfaction, numeric pain scores (NPS) at rest and with activity, and opioid intake. Patients were also classified by degree of saphenous nerve involvement in the operative procedure, by the surgeon who was blinded to the anesthesia randomization.
Patients in the dual-catheter group took significantly less opioid medication on the day of surgery and postoperative day 1 (POD 1) compared to the single-catheter group ( P = .02). The dual-catheter group reported significantly greater satisfaction with pain at POD 1 and POD 3 and a significantly lower NPS at POD 1, 2, and 3. This trend was observed in all 3 subgroups of medial operative involvement.
Patients in the single-catheter group reported more pain, less satisfaction with pain control, and increased opioid use on POD 1, suggesting dual-catheter use was superior to single-injection nerve blocks with regard to managing early postoperative pain in outpatient foot and ankle surgery.
Level II, prospective cohort study.
门诊进行的足踝手术范围不断扩大且复杂性增加，这需要更强化的围手术期镇痛。区域麻醉（腘窝和隐神经阻滞）已被证明能提供令人满意的疼痛管理，减少术后阿片类药物的使用，并使患者更早出院。通过放置连续流导管（通常插入腘神经区域）可进一步增强效果。本研究调查了在门诊足踝手术后的疼痛管理中，联合使用腘窝和隐神经连续流导管神经阻滞与单根腘窝导管及单次注射隐神经阻滞相比的效果。
对60例行门诊足踝手术的患者进行了一项前瞻性研究。记录了人口统计学数据、内侧手术累及程度、美国麻醉医师协会身体分类系统、麻醉时间和麻醉后护理单元时间。结果指标包括疼痛满意度、静息和活动时的数字疼痛评分（NPS）以及阿片类药物摄入量。患者还根据手术过程中隐神经受累程度进行分类，由对麻醉随机分组不知情的外科医生进行操作。
与单导管组相比，双导管组患者在手术当天和术后第1天（POD 1）服用的阿片类药物明显更少（P = 0.02）。双导管组在POD 1和POD 3时对疼痛的满意度明显更高，在POD 1、2和3时NPS明显更低。在内侧手术累及的所有3个亚组中均观察到这一趋势。
单导管组患者在POD 1时报告疼痛更多、对疼痛控制的满意度更低且阿片类药物使用增加，这表明在门诊足踝手术的术后早期疼痛管理方面，使用双导管优于单次注射神经阻滞。
II级，前瞻性队列研究。
