Dr. Peter Blume publishes once again in the Second Edition of Essentials of Regional Anesthesia

May 9, 2018 | posted in: Uncategorized | by

Regional Anesthetic Techniques
for Foot Surgery
Rick C Chen and Peter A. Blume
Introduction
Over the last decade, outpatient surgery has consistently
gained in popularity by providing a significant
reduction in the cost of hospitalization
and the patient’s length of stay. Foot and ankle
surgery procedures are commonly performed in
an outpatient setting [ 1]. Key issues in foot and
ankle surgery include rising demand for outpatient
procedures, managing postoperative pain
and decreasing the use of opiates, and avoiding
the side effects of general anesthesia in certain
patient populations [2].
Foot and ankle surgeries ,produce moderateto-
severe postoperative paih that is sometimes
difficult to control with oral pain medications
alone [3]. Research has shown that regional anesthesia
has been used successfully in foot and
ankle surgeries to reduce postoperative pain [1],
with one study reporting that regional anesthesia
reduces perioperative opioid requirements [ 4].
Another study indicated that monitored intravenous
sedation can be safely and effectively carried
out together with regional anesthesia in foot
surgeries. The article reported high patient satis-
faction and reduction in postoperative pain using
this combination [5]. Using monitored intravenous
sedation instead of general anesthesia significantly
reduces side effects, including nausea,
vomiting, and throat discomfort. Intravenous
sedation also reduces recovery time and avoids
unwanted admission to.the hospital [6]. The combination
of regional anesthesia with monitored
intravenous sedation can also be used in American
Society of Anesthesiologists (ASA) 3 and 4
patients undergoing lower limb-preservation procedures
without increasing their pulmonary or
cardiac complications. This finding is significant
because historically it has been assumed that
ASA 3 and 4 patients needed to be under general
anesthesia regardless of the surgical procedure
due to the higher rate of complications associated
with this patient population [7]. There are also
other specific patient populations in which
regional anesthesia may be a superior anesthetic
technique. Patients with asthma, for example,
benefit greatly from regional anesthesia because
it avoids airway manipulation [ 1].
Despite the numerous benefits of regional anesthesia
reported in recent studies, there is some
anecdotal evidence that performing regional anesthesia
increases operating room time and delays
turnovers [2]. However, with judicious preoperative
timing and planning as well as skillful regional
anesthesia administration, delayed turnover can be
minimized. This chapter discusses several common
regional anesthesia techniques in foot surgeries
and offers clinical pearls.

R. C. Chen, DPM
Family Foot and Ankle Physicians,
Greenville, NC, USA
P. A. Blume, DPM, FACFAS (181)
Affiliated Foot and Ankle Surgeons PC, Yale New
Haven Hospital, New Haven, CT, USA
e-mail: peter@ctfootandanklesurgery.com

© Springer International Publishing AG, part of Springer Nature 2018A. D. Kaye et al. (eds.), Essentials of Regional Anesthesia,

About the Author


Affiliated Foot and Ankle Surgeons are foot and ankle surgeons in New Haven, Connecticut. They provide the best podiatric care to patients with foot and ankle problems. Dr. Peter Blume and Dr. Farlyn Charlot-Hicks are Connecticut's best foot and ankle surgeons. You can contact them at (203) 397-0624.