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Background and goal of study: In comparison with other anaesthetic techniques, the popliteal block is a simple technique for forefoot surgery. Singelyn [1] et al. reported a success rate of 92%. After a 6 month introduction period in our institution, we performed a prospective study to evaluate success rate and complications.
Technique and methods: Following ethical committee approval, a popliteal block was performed in 50 consecutive patients scheduled for forefoot surgery. The saphenous nerve was blocked by injecting 10 mL of lidocaine 2% subcutaneously 5 cm below the medial surface of the tibial condyle. With the patient in the prone position the sciatic nerve was located using a nerve stimulator (1 mAmp, 2 Hz) and a blunt, insulated needle, using a posterior approach. Thirty mL of mepivacaine 1% with 150 μg catapressan was injected. Results are presented as mean values ± SD (min-max).
Results and discussion: Six men and 44 women, 50.5 ± 17 (16-85) years of age, were studied. Time to perform the block was 7.6 min ± 3.1 (3-15 min). Before injection of the local anaesthetic dorsal and plantar flexion of the foot was elicited in every case. The lowest current used was 0.36 mA ± 0.05 (0.27-0.49 mA). The time from injection to incision was 61 ± 27 (20-137) min. The block was sometimes performed well in advance of surgery and the patient was put in a holding area. The surgeon could start with the procedure at his or her convenience. Tourniquet pain was observed in two patients (4%). In four patients (8%) analgesia was insufficient for incision. A very low dose of intravenous opioids (fentanyl 25 or 50 μg) or a low dose of propofol (10 or 20 mg) provided adequate surgical conditions. No symptoms of local anaesthetic toxicity were observed. Postoperative analgesia lasted 449 ± 108 (240-805) min. No postoperative complications or sequellae were observed. While 46 patients would prefer the same anaesthetic technique again, three patients found it to be painful and one patient would have liked to have been more sedated.
Conclusion: The popliteal block is a simple, effective and safe anaesthetic technique for forefoot surgery. It also provides good postoperative analgesia without major side effects.
