Combined popliteal sciatic and subsartorial saphenous nerve block analgesia in ankle surgery

Background Sciatic and saphenous nerves are the two main nerves supplying the ankle joint. Theaim of this study was to evaluate the contribution of sciatic popliteal and saphenous nerve blocks to intraoperative and postoperative pain relief during and after major ankle surgeries. Methods A total of thirty patients were included in this prospective, randomized, controlled study. All patients in both groups (A and B) received general anaesthesia and intravenous morphine boluses for pain relief during surgery and intravenous morphine patient-controlled analgesia for postoperative pain relief. Using high-frequency ultrasound probe guidance combined with nerve stimulation, the patients in group B underwent sciatic and saphenous nerve blocks after induction of general anaesthesia.The sciatic nerve block was performed using a popliteal approach, whereas the saphenous nerve block was performed through the subsartorial canal. Approximately 20–30ml of levobupivacaine (0.5%) was deposited around the sciatic nerve, and up to 10 ml of the local anaesthetic was injected around the saphenous nerve. The intraoperative haemodynamic variables were recorded. The total intraoperative and postoperative morphine consumptions were also recorded. The pain score wasrecorded using the Visual Analogue Scale during the recovery and postoperative period, up to 48 h after surgery. Postoperative sedation, patient satisfaction, opioidrelated side effects, other postoperative complications, time to recovery-unit discharge and time to hospital discharge were compared between the two groups. Results The patients in group B had a significant reduction in the pain score during rest and movement during both the recovery and the postoperative period by more than 75% (P 0.05). Morphine consumption was significantly reduced in group B during surgery,and further reduced by more than 60% after ~48 h (P 0.05). Incidence of adverse effects and opioid side effects were more common in group A compared with group B (P 0.05). Patient satisfaction and early recovery and hospital discharge were higher in group B compared with group A. ConclusionThe combined sciatic (through the popliteal approach) and saphenous (through the adductor canal) nerve block provided better postoperative analgesia during rest and movement after major ankle surgery and improved patient outcome and patient satisfaction.