Efficacy of regional anesthesia using ankle block in ankle and foot surgeries: a systematic review

Mohammed S. Albaqami, Adel A. Alqarni

Department of Anaesthesia, College of Medicine, Majmaah University, Al Majma’ah, Saudi Arabia. adel_alqarni@hotmail.com

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• Anesthesiology

Ankle blocks are commonly used as surgical anesthetics and for postoperative analgesia during foot surgeries. It is chiefly an infiltration block which utilizes a localized anesthetic approach for providing surgical anaesthesia for a variety of foot procedures. Thus, in this systematic review, we focus primarily on the use, effectiveness, success and failures of regional ankle blocks in outpatient surgeries and hereby compare them with other anesthetic techniques and agents commonly used. Literature search was carried out using PubMed, Medline, Embase, Scopus and Cochrane Library for the studies existing till April 2021. Search was conducted by two independent reviewers separately keeping in view the structured format of the review. Data were thoroughly read and were extracted manually into a structured data extraction form. After going through the databases, 252 relevant articles were identified as per the search strategy. Among those 99 duplicate records were taken away. Among the remaining one hundred fifty-three records, one hundred thirty-eight records were excluded majorly going through their titles and abstracts. Next matching our inclusion criteria and going through the full texts, fifteen studies were excluded. Lastly, after excluding the reviews and case studies we included relevant 11 studies that compared the efficacy of ankle block in outpatient foot and ankle surgery in the present analysis. Seven studies used anatomic landmark guided (ALG) approach, three studies used ultrasound guided (USG) approach, while one study included both approaches. The results showed a significantly lower VAS score postoperatively at 24 hrs. It was observed that in general, immediately after surgery the VAS pain scores are low due to the continued analgesic effect provided by the ankle block. 0.25%-0.5% bupivacaine was the most common single long-acting local anesthetics used. Patient satisfaction ranged from 66%-95.8%. Major complications included block failure and consequent requirement of general anesthesia and few cases of transient nerve injuries. Therefore, this systematic review supports the fact that ankle block has advantages like excellent success rates with minimal side effects, high levels of patient satisfaction and decreased hospital expenses. Thus, it proves to be a safe and highly effective means of regional anesthesia for the majority of foot and ankle surgeries in outpatient settings.

 

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