The incidence of neurologic complications from foot and ankle surgery utilizing regional anesthesia is not well established.
The purpose of this study was to prospectively determine the incidence of neurologic and peripheral nerve block (PNB) site complications on a busy foot and ankle service that utilizes ankle blocks (ABs) and popliteal blocks (POPs).
Patients and Methods
This prospective observational study included patients undergoing foot and ankle surgery with ABs or POPs. Block choice was determined by surgeon’s preference. Patients were assessed for complications during postoperative visits at 2, 6, and 12 weeks. The relation of each complication to the block was scored by a surgeon and anesthesiologist.
From October 2012 to October 2014, 2516 patients underwent 2704 surgeries. There were 195 complications (7.2%) considered neurologic or at the PNB site. The incidence of serious complications was 0.7%. A higher complication rate was reported for POPs (8.8%) than for ABs (2.5%). However, when analysis was limited to forefoot surgery, this difference was not significant. Dexamethasone use was associated with increased complications for POPs. Only 5 of the 195 total complications, and 2 of 20 serious complications, were deemed to have been likely caused by the block by both the surgeon and anesthesiologist reviewer.
The incidences of neurologic or block-related complications and serious complications were 7.2 and 0.7%, respectively, most without a clear surgical vs. nerve block etiology. The higher complication rate for POPs using perineural dexamethasone should be interpreted cautiously in light of the lack of randomization and likely confounders.
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This work was presented at the American Orthopaedic Foot and Ankle Society Annual Meeting in July 2016 and the Society for Ambulatory Anesthesia Annual Meeting in May 2017. Thank you to Aaron Schweitzer for aiding in the preparation of this manuscript.
This work was supported by the Research and Education Fund of the Department of Anesthesiology at Hospital for Special Surgery. REDCap use was supported by the National Center for Advancing Translational Science of the National Institute of Health (UL1TR000457).
Conflict of Interest
Richard L. Kahn, MD, Scott J. Ellis, MD, Jennifer Cheng, PhD, Jodie Curren, MPA, BSN, Kara G. Fields, MS, and Matthew M. Roberts, MD, declare that they have no conflicts of interest. Jacques T. YaDeau, MD, PhD, reports receiving funds from Mallinckrodt Pharmaceuticals for a study outside this work.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was obtained from all patients for being included in this study.
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Level of Evidence: Therapeutic Study: Level III
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Kahn, R.L., Ellis, S.J., Cheng, J. et al. The Incidence of Complications Is Low Following Foot and Ankle Surgery for Which Peripheral Nerve Blocks Are Used for Postoperative Pain Management. HSS Jrnl 14, 134–142 (2018). https://doi.org/10.1007/s11420-017-9588-y
- regional anesthesia
- peripheral nerve block
- foot and ankle surgery
- ankle block
- popliteal block
- neurologic complications