Pascarella Giuseppe, De Quattro Eugenio, Strumia Alessandro, Del Buono Romualdo, Gargano Francesca, Ruggiero Alessandro, Migliorelli Sabrina, Schiavoni Lorenzo, Mattei Alessia, Cataldo Rita, Carassiti Massimiliano, Agrò Felice Eugenio, Costa Fabio
Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, 20122 Milano, Italy.
J Clin Med. 2025 Sep 6;14(17):6301. doi: 10.3390/jcm14176301.
Foot and ankle surgery is often associated with significant postoperative pain that may delay mobilization and recovery. For this reason, effective perioperative analgesia is essential to improve outcomes, minimize opioid use, and enable safe early discharge when appropriate. This review provides an updated overview of regional anesthesia techniques for foot and ankle surgery, highlighting anatomical considerations, ultrasound guidance, and patient-tailored block selection. Different techniques will be specifically addressed over neuraxial and nerve blocks, such as the Mayo block and intravenous regional anesthesia (Bier block), as well as the emerging WALANT approach for selected cases. Ultrasound guidance has become a gold-standard, enhancing precision and safety compared to landmark-based methods. Multimodal analgesia combining regional blocks with non-opioid medications and adjuvants like intravenous dexamethasone further optimizes pain control while limiting opioid requirements. In ambulatory settings, motor-sparing techniques and short-acting spinal agents are emphasized to support rapid recovery and same-day discharge. By integrating anatomical knowledge with ultrasound and multimodal strategies, perioperative pain management for foot and ankle surgery can be tailored to balance effective analgesia with early mobilization and patient safety.
足踝手术术后常伴有明显疼痛，这可能会延迟活动和康复。因此，有效的围手术期镇痛对于改善治疗效果、减少阿片类药物使用以及在适当的时候实现安全早期出院至关重要。本综述提供了足踝手术区域麻醉技术的最新概述，重点介绍了解剖学考虑因素、超声引导以及根据患者情况量身定制的阻滞选择。将特别讨论不同的技术，包括神经轴阻滞和神经阻滞，如梅奥阻滞和静脉区域麻醉（比尔阻滞），以及针对特定病例的新兴WALANT方法。与基于体表标志的方法相比，超声引导已成为金标准，提高了精确性和安全性。将区域阻滞与非阿片类药物以及静脉注射地塞米松等辅助药物相结合的多模式镇痛，在限制阿片类药物需求的同时进一步优化了疼痛控制。在门诊环境中，强调保留运动功能的技术和短效脊髓麻醉剂，以支持快速康复和当日出院。通过将解剖学知识与超声和多模式策略相结合，足踝手术的围手术期疼痛管理可以进行定制，以在有效镇痛与早期活动和患者安全之间取得平衡。
