Gbejuade Herbert, Squire Josephine, Dixit Anindya, Kaushik Vipul, Mangwani Jitendra
Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, Leicestershire, UK.
J Clin Orthop Trauma. 2020 May-Jun;11(3):417-421. doi: 10.1016/j.jcot.2020.02.010. Epub 2020 Feb 26.
The use of regional anaesthesia in foot and ankle surgery is becoming well recognised, particularly in patients who prefer to stay awake during the procedure and for better post-operative analgesia. Its use is ideal for patients with multiple co-morbidities, in whom general anaesthesia (GA) otherwise would could be challenging. The procedures performed with landmark/anatomical guidance alone carry a relatively higher risk of complications, risk of inadvertant injection into the intarvascualr space leadinf to local anaesthetic toxicity, the majority of which complications are caused by incorrect placement of the needle. Hence, ultrasound guidance is frequently used to minimise those risks. Although various regional anaesthetic techniques for foot and ankle surgery have been described, their comprehensive review is lacking. This manuscript aims to fulfil this void. The focus will be on the peripheral methods of regional anaesthesia including the plexus and single nerve blocks. Various techniques with their benefits and potential complications will be discussed. In addition, the evidence on the efficacy of an ultrasound-guided approach as well as its cost implications will be explored. There are significant considerations in deciding whether to implement this technique in routine clinical practice and this review aims to summarise the available literature to establish the evidence base behind it.
区域麻醉在足踝手术中的应用正日益得到认可，尤其是对于那些希望在手术过程中保持清醒以及获得更好术后镇痛效果的患者。对于患有多种合并症的患者，区域麻醉是理想选择，因为全身麻醉对这类患者可能具有挑战性。仅通过体表标志/解剖学定位进行的手术并发症风险相对较高，存在意外将局麻药注入血管内导致局麻药中毒的风险，其中大多数并发症是由针头放置不当引起的。因此，超声引导常被用于将这些风险降至最低。尽管已经描述了多种用于足踝手术的区域麻醉技术，但缺乏对它们的全面综述。本手稿旨在填补这一空白。重点将放在区域麻醉的外周方法，包括神经丛和单神经阻滞。将讨论各种技术及其益处和潜在并发症。此外，还将探讨超声引导方法的有效性证据及其成本影响。在决定是否在常规临床实践中采用该技术时存在诸多重要考量因素，本综述旨在总结现有文献以确立其背后的证据基础。
