[Analgesia in surgery of the foot. Apropos of 1373 patients]

Abstract

This retrospective study concerns 1,373 adult patients who underwent forefoot surgery during 1988-95 under regional anaesthesia by ankle nerve blocks (of posterior tibial nerve systematically and other nerves according to the surgical site). As a rule, plain bupivacaine 0.5% (maximum 40 mL) was used, completed if necessary by lidocaine 1% (a few mL). A nerve stimulator is currently used for posterior tibial blocks. About 50% of indications (such as hallux surgery) require short hospitalization (3 days). A catheter is inserted near to the posterior tibial nerve by the surgeon, allowing postoperative reinjections of 10 mL of bupivacaine 0.25% every 6 hrs by nurses, for 1-2.5 days. Other patients undergoing minor procedures (material removal, cysts, exostosis, etc.) can be operated on a day-care basis, without postoperative analgesic injections. Results were very satisfactory for both patients and surgeons. No general anaesthesia was needed (except after one case of convulsions, likely from accidental injection of a few mL of local anaesthetic and without any sequelae). Five patients complained of temporary paraesthesias, with indication of a posterior tibial neurolysis in one case and complete recovery. Thus ankle blocks appear increasingly to be a satisfactory alternative to general anaesthesia for most surgical procedures on the forefoot, provided that all usual safety conditions are respected and the patient's acceptance of the procedure is obtained.